Defense Dept. OIG substantiates lower cost of mail order in Tricare program

DoD experienced a 16.7% reduction in prescribing costs versus retail pharmacies

Express Scripts (St. Lous), the PBM that has a contract with DoD to run its Tricare Mail Order Program, is touting the results of a DoD Office of Inspector General (OIG) report that analyzed the cost of filling prescriptions via mail order versus drug stores. Tricare is the DoD program for military personnel and their beneficiaries, and currently has 9.6 million members. The conclusions: the mail-order option saved 16.7% of prescription costs surveyed (during Q3 of FY2012); prescriptions were filled with a 99.997% accuracy rate; and periodic patient surveys show a 96% “somewhat, very or completely satisfied” approval rating.

"We have developed a world-class capability to make the use of prescription drugs safer and more affordable,” said Nancy Gilbride, VP and GM of Express Scripts' Federal Pharmacy Services, “and we're pleased that the recent DoD Inspector General audit confirms what we see every day: home delivery through a mail order pharmacy is the safest, most cost-effective way to receive prescription drugs."

Some caveats: the analysis included only non-specialty maintenance pharmaceuticals; the OIG noted that generics cost DoD more through the mail-order program than through retail pharmacies, but that the savings on branded drugs more than offset that higher cost; and (strangely), Express Scripts could not provide data on waste due to pharmaceuticals being delivered that were no longer needed. (The latter is a contention of retail pharmacy advocates, who have collected reports of 90-day supplies of drugs being delivered under auto-refill programs, and then billed, for patients who didn’t want them.) Also, it’s worth noting that DoD made Tricare mail-order substantially more attractive to patients by eliminating copays on generics when mail order is used.

The savings that OIG documented are not surprising; earlier studies had confirmed much of the same results. But community pharmacy advocates like the National Community Pharmacists Assn. contend that mail order reduces or eliminates the care that face-to-face pharmacist interactions with patients can provide, and continues a fight against mandatory mail order and other elements of such programs.