Express Scripts' New Plan: Prescription Drugs Go to Employees' Homes

Reader Comments
Back to blog

I have to admit I believe many of the comments posted are more accurate and a better read than the article itself (no offense intended to the author). Specifically Kathy, Dr. Mibradt and the Angry Advocate...nice input. First, medication possession (medications mailed to the house on time) and compliance are two vastly different parameters. The first one, which is what Express Scripts is talking about, is good for their business model; the second one, compliance, is good for patient care. There are a number of studies showing that face-to-face interaction with a health care professional, particularly a pharmacist in this case, has a greater improvement in overall compliance and patient outcomes.
So if companies like Express Scripts really wanted to improve patient care why would they not put a program in place to pay pharmacists better to take care of patients and improve real compliance? That was obviously a rhetorical question. This program really has nothing to do with patient care but instead it is about driving their own business model of being both the payer of pharmacy benefits and the provider of the product. Not to pick on Express Scripts alone because most large PBM’s are in the same boat, they are the payer or intermediary and they are also a provider. What would make us think they would not do whatever they could to drive business to themselves? This is the goal of mandatory mail programs or programs such as this one presented here. To drive revenue and increase shareholder value.

Joe of MA 8:16AM March 26, 2009

As others have stated, this article comes off as nothing more than a ridiculous ad for Express Scripts. Here are a few FACTS that the “hard-hitting journalist” declined to mention:
1. Studies have shown that mail order pharmacy options don’t appreciably reduce drug costs for those who end up footing the bill (i.e. health insurance plans).
2. It’s a HUGE conflict of interest for PBMs (which are hired to manage drug costs) to pay themselves for the mail order prescriptions they fill in these pharmacies.
3. It’s well known that PBMs use various deceptive techniques to end up paying themselves MORE to fill prescriptions in their mail order pharmacies.
4. Using multiple pharmacies (such as one pharmacy for chronic medications and one pharmacy for acute medications) can literally KILL you due to unforeseen drug interactions.

Dr. Jacob Milbradt of KS 12:16AM March 26, 2009

I can see why Express Scripts wants to do this, but why is U.S. News falling for this nonsense and acting like a shill for Express Scripts? Express Script’s reason for instituting these programs has nothing to do with improving patient care.
It is a well known fact that most people prefer getting their prescriptions at retail if given the choice, but Express Scripts makes most of its money on mail, hence the opt-out program that defaults to mail. They are banking on the fact that many people will be too lazy to deal with the red tape involved in switching to a retail option.
Even more troubling is the fact that Express Script’s Select Home Delivery program automatically mails patients 90-day refills of their medications. The big thing missing here is the human element - a pharmacy professional, confirming that the patient has been taking his/her meds as directed, and if not determining the reasons for non-adherence and helping the patient work through any issues (side effects, confusion about instructions, etc.). Without at least a phone call with the patient confirming the need for more meds, this practice may even constitute fraud, waste and abuse for Medicare Part D and Medicaid prescriptions under CMS rules.
Bob Nease’s comment that "Moving from retail to home delivery may be the most powerful intervention we have today to improve therapy adherence," is a joke, and he should be ashamed of himself for making that kind of statement as “Chief Scientist” for Express Scripts. The most powerful intervention we have today to improve therapy adherence is face-to-face interaction between a trusted pharmacist and a patient, and that’s what we should be incenting and encouraging.
I expect a more thoughtful analysis from U.S. News – this article reads more like an advertisement.

Kathy from Northbrook of IL 6:19PM March 25, 2009

This is mearly a tool to increase your plans drug usage.
This is what they learned from the financial sector "Churning".

errol of NY 4:12PM March 25, 2009

I'd like to see two statistics after this program has been operating for a year:
1) % increase in revenues generated by the PBM owned mail order pharmacy
2) % of medications that were shipped but never taken
I once knew a woman, who after her husband's death, tried to return his unused medications. There were enough of them to fill the trunk of her Oldsmobile! The reason: auto shipments from mail order.
Distributing drugs via mail order may be cheaper than retail, but when you auto ship meds that aren't being used (much less being used correctly), there is a net INCREASE in costs with no associated increase in value.
Other problems I'd think people would be concerned about:
- Environmental impact associated with the disposal of unused medications
- Accidental poisonings caused by people having too many/too much medication lying around their homes.
When are these folks going to get it through their heads that they need worry about more than getting the cheapest drug from A to B as cheaply as possible?

Angry Advocate of MA 3:27PM March 25, 2009

Turn to MedTipster online for discounted drugs and generics!

kyle of MI 2:44PM March 24, 2009

I'm the daughter of two parents who are signed up with this program. We hate it. They never said we could opt-out and it has made getting a simple prescription filled and huge chore.

chicago of IL 12:54PM March 24, 2009