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By Suzanne Blake
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A new report has revealed that Medicare spent $3 billion giving recipients extra drugs they didn’t need.
The Wall Street Journal published findings this week that excessive refills of drugs cost Medicare and its patients $3 billion between 2021 and 2023.
Why It Matters
The additional refills came to seniors despite being unnecessary in many cases, leading to widespread waste across the Medicare system, the report found.
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Some extra medications could also lead to accidents if patients took too much or consumed the incorrect drug, according to the report.
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What To Know
Regulators loosened restrictions on early refills during the pandemic as mail-order pharmacies became more common.
According to the Journal, mail-order pharmacies filled 9 percent of Medicare prescriptions during the three-year time period but made up 37 percent of excess prescriptions. Many patients will get these refills automatically on a 90-day schedule.
“During the pandemic, refill rules were relaxed to prevent patients from running out of medication,” Kevin Thompson, the CEO of 9i Capital Group and the host of the 9innings podcast, told Newsweek. “Those policies lingered, and when combined with automatic and mail-order refill programs, many Medicare beneficiaries began receiving prescriptions earlier and in greater quantities than needed. Because the refills were processed and billed, Medicare paid for them under existing rules.”
While the ease of getting automatic refills can help patients who stay on a certain type of drug indefinitely, an oversupply can lead to medical issues and financial waste.
The biggest U.S. mail-order pharmacies are owned by mega corporations like UnitedHealth, Humana and Aetna.
“The alternative—members becoming gravely ill due to lack of medication—is far more harmful to patients and costly to the health system,” a UnitedHealth company spokesman said.
Because the pharmacies themselves make revenue from dispensing drugs, they are often incentivized to make more, even if there’s no actual need to.
Every year, Medicare spends more than $100 billion on drug benefits, and the three-year period revealed pharmacies were dispensing more than 30 extra days of diabetes treatment Jardiance almost 200,000 times. That collectively costs taxpayers $111 million.
The insurance companies in charge of the refills say much has changed since the three-year period studied by the Journal. UnitedHealth said it blocked up to five times as many early refills in 2024 as in 2021 and 2022.
Humana echoed this statement, saying its current protocols “strike the right balance, allowing sufficient time to fill and ship prescriptions and supporting medication adherence without encouraging stockpiling.”
What People Are Saying
Kevin Thompson, the CEO of 9i Capital Group and the host of the 9innings podcast, told Newsweek: “The impact goes beyond waste. Excess medications increase the risk of confusion, dosing errors, and misuse among seniors, while unnecessary drug spending raises overall costs within Part D. Long term, this highlights a misalignment of incentives and will lead to tighter oversight of automatic refill practices.”
Alex Beene, a financial literacy instructor for the University of Tennessee at Martin, told Newsweek: “No one is ridiculing Medicare recipients for seeking early refills on prescription drugs they need frequently, especially with its leads to an easier process for them to manage their healthcare situation. At the same point, too frequent and excessive refills create an environment where many pills stay stashed in the homes of recipients unused and use more Medicare funds to the tune of $3 billion over a three-year period.”
What Happens Next
The Wall Street Journal’s analysis has called into question the refill policies of top Medicare providers while insurers still look to support the prescription needs of patients in a timely manner.
“Ultimately, there has to be a better balance, and recipients being proactive but not excessive with future refills could ensure not just a better environment for their health, but also lessen the funding waste Medicare has accumulated in recent years,” Beene said.
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