MaineCare Policies to Prevent Pharmaceutical Waste

1. MaineCare Policies to Prevent Pharmaceutical Waste Jennifer Palow Pharmacy Director

2. Curbing wasteControlling cost

3. Pharmacies in Maine were once allowed to give an early refill for prescriptions at their discretion. We found that pharmacies used this to bypass some PA requirements. In 2005, the Maine pharmacy program eliminated this override process.

4. In 2006 the Department added policy that discontinued advanced refills for vacationers and denied request to replace lost medications.

5. In the summer of 2009, MaineCare introduced a fifteen day initial prescription supply limit. MaineCare staff and associates began developing the program for various medications that have been identified with high side effect profiles, high discontinuation rates, or frequent dose adjustments to ensure cost effectiveness without “wasting” or “discarding” of used medications.

6. In the first year the Department saw a savings of nearly $500,000.

7. The department periodically reviews the list of drugs in the 15 day initial script program. We are careful not to add medications that would cost the Department to dispense twice.

8. Challenges during implementation included the additional work for providers. We allowed the provider to write one script for the full month and the pharmacy to only dispense for 15 days at a time. Additional challenges included making sure this program remained cost effective and actually produced savings.

9. The drug classes included are typically those that would have side effects, a high discontinuation rate or dose changes. The list of drugs can be found on the website – www.mainecarepdl.org

10. The most recent change in policy for waste control is reducing mail order from refill tolerance allowed at 85% to anything prescribed over 60 days to be a 90% RTA.

11. During an audit in 2010 the Department found that mail order patients receiving 90 day fills were receiving an extra month of drugs annually.

12. State wide efforts to clean up wasted medications include take back days, drop off sites at participating pharmacies and police stations and in some areas the TRIAD will pick up unused medications.

13. Questions?