Lee asked
Should I switch to 90-day refills? Hi I get my birth control, Heather to be exact, from CVS Pharmacy and I got a letter in the mail asking that I switch from 30-day refills to 90-day refills. If I stick with the 30-day refills it says that I will have to pay 100% of the cost of my medication. Is this true even though my insurance covers it? I usually get my birth control for free. I don't want to pay.
Answer
Whether or not it is mandatory for a prescription to be filled at mail order, is determined by your pharmacy benefits plan design. This plan design is determined either by your medical insurance or more often than not, by a pharmacy benefit manager (PBM) that has been contracted by your employer or medical insurance.
Some plans do have a mandatory mail order plan design where maintenance medications, medications prescribed for chronic, long-term conditions, are required to be filled through mail order after so many fills at the local, retail pharmacy. In this case, your birth control would be considered a maintenance medication.
There are often benefits to using a mail order pharmacy. Some of these benefits include:
- Prescriptions are delivered to a patient's home, saving time
- The copay at mail order may be lower than at a retail pharmacy depending upon pharmacy benefits
- 90 day supply at mail order vs 30 day supply at retail
- Compliance often is increased when patients use mail order
A study reported in the Journal of Managed Care and Specialty Pharmacy found that adherence to medication was increased when patients utilized mail order pharmacy versus retail pharmacy. In other words, patients were more likely to take their medication as directed. Not taking medication as directed, can lead to decreased outcomes for patients and possibly worsening of their conditions. In the case of birth control, this would include unintended pregnancy.
Summary
Mandatory mail order use for medication refills is determined by your pharmacy benefit plan design. While it may not be something that patient's initially want to use, there are many benefits to using a mail order pharmacy, including convenience and possibly cost savings on prescriptions. Any further questions about mandatory mail order use should be directed to your pharmacy benefit manager.
