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
TABLE OF CONTENT
- HUMANA MED.ADV./ CENTERWELL PHARMACY
- AETNA MED. ADV. & COMMERCIAL/CVS CAREMARK
- UNITED MED. ADV. & COMMERCIAL; IBC COMMERCIAL / OPTUMRX
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.
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
- Potentially lower medical and prescription cost for fills and refills
- Humana’s CenterWell pharmacy waives copays for Lower income subsidy (LIS) patients for tier 1-4 drugs
- More information on Extra Help (LIS), eligibility and benefits can be found on Humana’s website: https://www.humana.com/medicare/medicare-resources/what-is-medicare-extra-help?kc=0300041012
- 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.
- E-prescribe: Select “CenterWell Pharmacy Mail Delivery” in your e-prescribing software
- Fax: Send the provider fax form to 800-379-7617
- Phone: Call CenterWell Pharmacy at 800-379-0092 (TTY: 711), Monday – Friday, 8 a.m. – 11 p.m., and Saturday, 8 a.m. – 6:30 p.m., Eastern time.
- Website: https://www.centerwellpharmacy.com/prescriber-information.html
- E-prescribe: e-Prescribe to CVS Caremark Mail Order Electronic, NCPDP ID 03220389501 East Shea Blvd, Scottsdale, AZ 85260
- Fax: Send FastStart New Prescription Fax Form to 1-800-378-0323
- Phone: Call CVS Caremark at 1-877-864-7744 (TTY: 711) Monday through Friday 9a.m. to 7:30 p.m. (ET)
- Website: https://www.caremark.com/pharmacists-medical-professionals.html#acc_uuid9b8eafe0-5265-4bc3-bfa9-32c3324fcd25
- E-prescribe: Optum Home Delivery (Optum Rx Mail Service) 6800 W 115th St., Ste.600, Overland Park, KS 66211-9838, ID: 1718634
- Fax: Send Physician Fax form to 1-800-491-7997
- Phone: Call Optum at 1-800-791-7658
- Website: https://www.optum.com/business/providers/pharmacy/home-delivery/electronic-prescribing.html
- E-prescribe: 1020 N Delaware Avenue, Philadelphia PA 19125 Phone: 267-534-5025;267-324-5347; NPI: 1053881573
- Fax: 267-324-5418
- Phone: Call Centennial Pharmacy at 267-324-5347
- Online Portal: http://www.centennialpharmacy.com/referrals
- Centennial Referral Guide for DVACO Ecosystem
- Website: https://www.centennialpharmacy.com/providers
- *Home visits offered for pharmacy care needs*
- 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
- Phone: Call Morrell Park Rx at 267-329-4900
- Website: https://morrellparkrx.com/prescription-transfers/
- *Home visits offered for pharmacy care needs*
- Pharmacy Measures Resource Document
- Generic Payor Agnostic Medication Adherence Flyer (also provided in patient education materials)
- Centennial Pharmacy Services Talking Points
- Centennial Pharmacy Services Medication Management Education Deck
- Optum Home Delivery Overview Flyer
- Optum Bolster Solution Provider Flyer
- Mail Order Pharmacy Prescribing Information
- Suggested Care Management Workflow
- Suggested Office Workflow Example
- Humana MA/Center Well Pharmacy Flyer
- Aetna MA/ CVS Caremark Flyer
- United MA/ Optum Rx Flyer
- Generic Payor Agnostic Medication Adherence Flyer
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?
- High Cholesterol
- Blood Pressure
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?
- 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?
- 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?
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?
How are medications protected during the shipping process?
My patients tried mail order pharmacies during the COVID-19 pandemic and had negative experiences. Why is this different?
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?
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?
What happens if the patient’s medication isn’t filled on time? What’s the standard process?
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?
What is your process to change the patient from their current pharmacy to mail order? Are one-time fills excluded?
Do you offer Pill Packs/Blister Packs via Mail Order?
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?
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?
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?
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.
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