DVACO-Mail Order Pharmacy Toolkit

Created by: DVACO Care Continuum, Quality Improvement, and Practice Transformation Teams upon the recommendation of the DVACO Clinical Integration Committee
Date: October 2023
Version 1.2

TABLE OF CONTENT

INTRODUCTION

MAIL ORDER PHARMACY BENEFITS

PAYOR MAIL ORDER PHARMACY

INDEPENDENT MAIL ORDER PHARMACY

PROVIDER & PRACTICE RESOURCES

PATIENT RESOURCES

FREQUENTLY ASKED QUESTIONS (FAQS)

REFERENCES

Introduction
Patients who utilize mail order for their prescription medications experience numerous benefits, including superior medication adherence rates, improved patient satisfaction, increased savings, and better health outcomes. Medication adherence refers to whether patients take their medications as prescribed. For the HEDIS medication adherence measures, patients are considered adherent if they refill their prescriptions at least 80% of the time. Improved medication adherence can positively impact a patient’s health care outcomes as well as impact hospital admission and readmission rates, resulting in improved performance in value-based care. Below is information and resources regarding the benefits of utilizing payor Mail Order Pharmacies to help guide conversations with your patients.

 

Mail Order Pharmacy Benefits

Medication Adherence Benefits
Mail Order pharmacies are just one of many solutions that can contribute to increase medication adherence. Patients who use mail order pharmacies for their medication fills have been found to:

  • Demonstrate superior medication adherence rates
    • Prescription non-adherence accounts for 50% of treatment failures, nearly 125,000 deaths, and up to 25% of hospital stays each year in the U.S. 1
  • Experience lower hospital admissions and readmissions
    • Reduced hospital admission/1000 by up to 30% 2
  • Consistently outperform retail pharmacies in CAHPS survey and Medicare Advantage Stars performance due to the extra layer of support from payor pharmacies
    • Medication adherence measures are heavily tied to quality performance (Triple-Weighted measures) and thus revenue
  • Increased Pharmacist support for our shared populations at no cost to the DVACO network
    • Assistance with identifying and transitioning to lower cost drug equivalents
    • Increase generic dispensing rates where appropriate
    • Payor Specific Mail Order Pharmacy Information is provided

 

Patient Benefits
Below are additional patient benefits of utilizing Mail Order Pharmacies:

  • Potentially lower medical and prescription cost for fills and refills
  • Auto-fill of prescriptions are available as needed
    • Mail order pharmacies have programs to sync the fill dates for prescriptions
  • Some mail order pharmacies offer daily blister packs
    • This can remove confusion from medication management and ensure that patient stake their medications as prescribed
  • Local mail order pharmacies such as Centennial and Morrell Park offer home visits for patients that need more assistance and provide communication back to the PCP on patient status

 

What Can You do to Help? Providing education about mail order pharmacy has been shown to increase its utilization.

  • Discuss the benefits of mail order pharmacy with your patients at office visits and during patient outreach.
  • Encourage patients to review their prescription plans to learn more about their mail order benefits.
  • Engage your office staff to offer suggestions and implement workflows to assist in these efforts.

 

Payor Mail-Order Pharmacy
Help patients set up mail-order prescriptions through their associated health plans by using any of the following methods:

Humana Medicare Advantage
CenterWell Pharmacy

 

Aetna Medicare Advantage & Commercial
CVS Caremark

 

United Medicare Advantage & Commercial IBC Commercial
OptumRx

 

Independent Mail Order Pharmacies

Centennial Pharmacy Services

 

Morrell Park Pharmacy

  • E-prescribe: Select “Morrell Park Pharmacy, 3808 Morrell Avenue” in your e-prescribing software and pharmacy staff will reach out to patient to patient to confirm pick up versus home delivery; NPI: 1750926119
  • Fax:267-329-4901
  • Phone: Call Morrell Park Rx at 267-329-4900
  • Website: https://morrellparkrx.com/prescription-transfers/
  • *Home visits offered for pharmacy care needs*

 

Provider & Practice Resources

 

Patient Resources

 

Frequently Asked Questions (FAQs)
 
Don’t see your question below?
The DVACO continually works with our pharmacy partners to ensure our providers and patients are equipped with the information they need to guide the use of mail-order pharmacy. To submit additional questions, please email us.

What types of medications are eligible for mail order pharmacy?
Mail Order Pharmacies primarily deliver maintenance medications that patients take on a regular, recurring basis for chronic, long-term conditions such as:

  • Diabetes
  • High Cholesterol
  • Blood Pressure
  • Asthma

Short term and trial medications should not be filled with a mail order pharmacy.

How would a patient transition their current retail prescription(s) to the Mail Order Pharmacy of their choosing?
There are multiple ways to transition over to a Mail Order pharmacy.

  • If ordering from the doctor’s office, the doctor will need to send a new prescription to the patient’s preferred mail order pharmacy.
  • If a patient wants to switch their prescriptions over to a payor associated mail order pharmacy, the associated pharmacies require the patient to sign-in to their account to transfer or manage their prescriptions or patients can contact the associated pharmacy customer service lines.
How do I pay for my mail order pharmacy prescriptions?
Payment is typically required before the order is shipped. Most mail order pharmacies accept debit and credit cards, and some may accept electronic checks over the phone. The following pharmacies offer alternative payment options:

  • Center Well Pharmacy – Accepts personal checks or money orders.
  • CVS Caremark – For online transactions, CVS Caremark accepts debit cards and electronic checks. If ordering by mail, they accept checks, money orders, and debit cards.
  • OptumRx – Accepts debit card or bank account information.
  • Centennial Pharmacy – Prelabeled payment envelopes can be included with deliveries to mail back cash or a check.
  • Morrell Park Pharmacy – cash or check payments at time of local delivery can be set up on a case-by-case basis.

For more information on payment options, please contact the prescribing mail order pharmacy.

How long will it take for the patient to receive their medication via mail order?
There are varying shipping and arrival periods depending on the mail order pharmacy used and the prescription(s) ordered. Most mail order pharmacies recommend ordering prescriptions at least three weeks before the patients need their refill. Please contact preferred mail order pharmacy for more information on shipping and delivery timeframes.
Many of my patients are apprehensive about packages being sent to their home due to theft and/or concerns about the postal service, what do I tell them?
Mail theft is a real concern that many of your patients may have. The United States Postal Service (USPS) have taken several steps in the last several years to make the mail delivery service more secure. In general, all mail order prescriptions are in secure, discrete packaging that is tamper-evident and weather-resistant. There are no identifiers on the packaging that would lead curious thieves to believe the contents are valuable or from a pharmacy. The USPS recommends that patients receiving their medications through the mail take steps to prevent mail theft including, checking their mailbox daily, signing up for informed delivery though USPS, and taking note of what time of day your mail gets delivered.3 All mail order pharmacies have customer service teams to help with reshipment if medications do go missing.
How are medications protected during the shipping process?
Mail Order pharmacies follow strict quality and safety procedures to make medications arrive safely and securely. Medications that require refrigeration, for example, may be shipped overnight or via next-day delivery in insulated packaging with a cold gel pack. Other medications may be shipped in bubble wrap to protect against moisture. There are specialized shipping procedures that prevent medications from freezing and spoiling. These special shipping methods have no added cost for the patient.
My patients tried mail order pharmacies during the COVID-19 pandemic and had negative experiences. Why is this different?
During the COVID-19 pandemic mail order pharmacy struggled due to the United States Postal Service experiencing higher than normal mail volumes as well as staffing shortages. Since the effects of COVID-19 have subsided, mail volumes, as well as staffing have returned to normal levels. The mail order pharmacies listed above are now seeing shipping times comparable to pre-COVID numbers. Most mail order pharmacies expect delivery within 7 to 10 days from shipment.
I have patients that hop from one pharmacy to another to save money by using Good Rx coupons. How does that fit into the mail order pharmacy strategy?
It would be advisable to caution against this practice. The claims for prescriptions filled by Good Rx coupons do not go through payor pharmacies and therefore, the prescription is not counted as being filled, and the patient will be counted as non-adherent. If a patient is having financial difficulty and cannot afford their copays, each mail order pharmacy will work with the patient to assist in helping with copays so the patient can fill their prescriptions. Please have patients reach out to their payor pharmacy for assistance.
I have some patients that stockpile medications. Doesn’t this disrupt fill history and adherence data? Does DVACO have other ways to measure medication adherence?
Using a mail order pharmacy is a way to prevent patients from stockpiling medications. There is communication between mail order pharmacy and patient where the pharmacy will be aware that the patients have more medication than needed.
What happens if the patient’s medication isn’t filled on time? What’s the standard process?
If there is a delay, obtain a short supply at local pharmacy. There is an expedite order option at no cost and moved the order up on queue. Expedited shipping is an option at additional cost.
Who does the patient call?
  • Humana- CenterWell Pharmacy Call Center. 800-379-0092 for regular scripts. For Specialty drugs – 800-486-2668. Members can also connect with the Call Center via the Chat feature on the Web.
  • Aetna- Member services on the back of their card.
  • United- The number on the back of their ID card.
What if the medication gets lost in the mail? What is the process to recover undelivered mail?
  • Aetna- Process for lost or delayed mail is monitored by specific team. The team will reach out to mail carrier, if that is unable, they reship. They then check back in to see if original shipment was ever received resulting in surplus medication.
  • Humana- the current rate at which Humana mail order medications need replaced for any reason is 0.33%. If medications do get lost in the mail or are stolen this can be reported using the number on the back of the member card and a replacement will be sent
  • United- United’s year to date reported lost package rate is 0.0009%. Medications that are lost before being received by the member are replaced and shipped overnight at United’s expense.
When do the refills come?
This can depend on if a patient chooses to have automatic refills. However, refills generally are filled and shipped 10 days prior to when the next refill is due.
What is your process to change the patient from their current pharmacy to mail order? Are one-time fills excluded?
No, one-time fills are not excluded. You can get one-time medications filled via mail order pharmacies.
Do you offer Pill Packs/Blister Packs via Mail Order?
No payer pharmacies offer Pill Packs/Blister Packs. However, the two independent pharmacies listed above do offer Pill Packs/Blister Packs through their Mail Order Pharmacy.
Is there a way to synchronize fills?
  • Aetna- No. Auto-refills is the only automation process.
  • Humana- Humana has a Medication Synchronization program that aligns timing of refills to a single delivery date every 90days. The scope is currently MAPD Individual with specific eligibility criteria but if there was a compliance need to be able to synchronize specific members/LOB we may be able to depend on volume.
  • United- If a patient calls customer service and refills are available for additional medications within 5 days of a fill request, the customer service agent will offer to process these meds together. When medications are on auto refill, if multiple medications are set to fill within 9 days of each other, they are bundled for processing and shipping. If orders are placed for multiple medications within 30 minutes of one another, they are shipped together in the same package.
What is your process for reaching out to a patient once a new rx is received form a provider?

Under all insurers, once the prescription is received by the provider, the pharmacy will reach out to the patient by phone, or by online portal (if it is a returning customer) to obtain consent for mailing and a payment method.

Some of the fax numbers do go to an email. Is this something that is checked constantly throughout the day?
Yes, fax’s regularly are monitored by a specific team.
If care coordinator or the practice outreach patients and provider send a prescription to mail order pharmacy, will the pharmacy fill the medication or place it on hold?
The very first time someone uses mail order, that order is stopped for “ship consent.” That first order cannot ship without specific consent from the member at the time of shipping. For all subsequent orders, once the pharmacy receives a prescription, the pharmacy puts it through claims, if it is due, they will fill it, if it is not due, they will fill it when the claims allow it to be filled.
If the medication is on hold, will the pharmacy automatically refill the medication when the patient is due, or will the patient have to call pharmacy?
If the patient is opted into automatic refills, as soon as the refill is available it will get filled. If the patient is not opted into automatic refill, they will need to request a refill by calling or using their online portal.

DVACO measures health indicators for your patients such as emergency room visits, hemoglobin A1c, blood pressure, eGFR, and uACR. We believe that improved medication access and adherence through our mail order pharmacy strategy will have positive downstream effects on these numbers. Thank you for your efforts to support this important clinical strategy for the physician networks of the DVACO. This toolkit will be updated on a regular cadence, and you will be notified when changes are made. We are working closely with our payor and pharmacy partners to answer all questions that arise as this strategy is rolled out. Again, we thank you for your collaboration in this effort.

 

References
1 Kim, J. & Combs, K. & Downs, J. & III, Tillman,. (2018). Medication adherence: The elephant in the room. U.S. Pharmacist. 43. 30-34
2 Hospital admits/1000 were 27%, 21%, & 30% lower for Humana members filling at CenterWell Pharmacy w HTN, DM, hyperlipidemia respectively
3 United States Postal Inspection Service. (2023, July 10). Mail & Package Theft. Retrieved from https://www.uspis.gov/tips-prevention/mail-theft

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