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Early prescription refills by mail-order pharmacies cost Medicare and patients $3 billion over two years, from 2021–2023, according to a report by The Wall Street Journal.
Mail-order pharmacies run by UnitedHealth and Humana were found to have the most cost overruns.
Excessive refilling is common practice at U.S. mail-order pharmacies, the WSJ analysis found. This was especially true during the COVID-19 pandemic, when the government relaxed rules that Medicare had in place setting limits on early prescription refills.
Both UnitedHealth and Humana said that since 2023, when COVID-19-era emergency rules ended, they have rejected more early refills than the period considered in the study, according to the report.
“The data does not reflect current practices,” a spokesperson for UnitedHealth said. The company said it denied up to five times as many early refills in 2024 compared to 2021 and 2022.
Humana argued that its current practices “strike the right balance, allowing sufficient time to fill and ship prescriptions and supporting medication adherence without encouraging stockpiling,” the report said.
Based on details of each prescription sent to more than 50 million Medicare beneficiaries between 2021 and 2023, WSJ found that mail-order pharmacies accounted for 37% of the excess dispensing even though they filled only 9% of Medicare prescriptions, according to Seeking Alpha.
Some insurers require their customers to use 75% of a prior supply, or day 68 for a 90-day refill, before sending prescription refills. However, according to the report, UnitedHealth’s mail-order pharmacies sent refills sooner than the 68-day threshold 11% of the time, nearly nine times faster than other Medicare pharmacies.
Over the three years, UnitedHealth delivered $142 worth of excess medications per Medicare patient, the most among any major pharmacy operator, while Humana was second with $93 worth of extra drugs per recipient.
CVS Health’s mail-order pharmacy and Cigna’s Express Scripts cost Medicare $45 and $44 worth of extra medications per patient, respectively.
Email the writer: SMorse@himss.org