NACDS, NCPA call PBM-sponsored study of mail order vs. retail pharmacies biased

Retail pharmacy groups criticized a new study suggesting that adherence to oral antidiabetic medications improves when patients use mail-order pharmacies.

The study, published online in the Journal of Medical Economics, examined 22,546 Medicare Part D patients with diabetes. Among patients using mail-order pharmacy, adherence to metformin and other oral diabetic medications was 49.7%; among patients who received their prescriptions from retail pharmacies, 42.8% were adherent.

The study was conducted by Prescription Solutions by OptumRx, the largest pharmacy benefits manager (PBM) for Medicare Part D.

Executives with the National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Association (NCPA) reviewed the study and did not agree with its findings. “It does not measure actual adherence to oral antidiabetic medication. Instead, it equates mailing a 90-day supply of a prescription medication to a patient with adherence to that particular medication. It does not take into account whether that medication was actually taken as prescribed, if the patient had an adverse reaction, or if the prescriber stopped or changed the dosage of that medication based on the patient’s need,” said Steven Anderson, president and CEO of NACDS.

“This is yet another example of a PBM-funded study that produces results that favor the supposed medication adherence benefits of mail order. Adherence is not about the possession of prescription drugs, as is the case in most of these types of studies. Adherence is about actual results for patients,” said John Norton, a spokesman for NCPA.

In addition, NCPA pointed to a different recent study published in the American Journal of Managed Care, which found that patients who were new to mail order had a much lower adherence rate using mandatory mail order, compared to voluntary mail-order use. “This study shows that mail order actually decreases adherence, while the [Journal of Medical Economics] study follows the usual scenario: pro-PBM-biased results, in keeping with the desires of their main funders - the PBMs,” Norton said.