Characteristics of Medicare Part D Beneficiaries with Alzheimer’s Disease and Related Dementias (ADRD) Using Mail Order Pharmacies

OBJECTIVES: Mail order pharmacies can provide convenience for ADRD patients and have been linked to increased pharmaceutical adherence. This study examined the demographic and clinical characteristics of mail order users among patients with ADRD, comparing to retail pharmacy users.

METHODS: We used the 2021 Medicare claims (20%) sample to descriptively characterize Medicare Part D beneficiaries by mail order and retail pharmacy use. Our final sample included 121,754 Medicare beneficiaries with ADRD at the end of 2020 who were “home” all year and had at least one claim in 2021. We designated beneficiaries with greater than 50% of their prescription drugs’ days supplied via mail order as mail order pharmacy users and beneficiaries with greater than or equal to 50% of their prescription drugs’ days supplied via retail as retail pharmacy users.

RESULTS: Of the 121,754 total beneficiaries included in the sample, 37,987 (31%) had Alzheimer’s disease and 83,767 (69%) had related dementias. 108,766 (89.3%) were classified as retail pharmacy users and 12,988 (10.7%) were classified as mail order pharmacy users. 87% of mail order pharmacy users were white, compared to 70% of retail pharmacy users. 6% of mail order pharmacy users were dually eligible beneficiaries (enrolled in both Medicare and Medicaid), compared to 34% of retail pharmacy users.

CONCLUSIONS: Among Medicare beneficiaries, mail order pharmacy users were less likely to be of minority race and were less likely to be dually eligible for Medicaid compared to retail pharmacy users. This research enables us to discern where non-institutionalized ADRD patients are obtaining their prescription drugs (mail order versus retail pharmacy) in Medicare Part D. This is important given that using mail order versus retail pharmacies may result in different spending or adherence outcomes.