NCPA: Patient Survey Finds Widespread Problems with Mail Order Pharmacies

Many patients go without their prescribed medicine due to the slow or ineffective service of mail order pharmacies, according to a survey of just over 400 patients conducted by the National Community Pharmacists Association (NCPA). The findings both raise troubling questions about the impact mail-order programs have on patients and contradict two purported benefits of mail order: increased convenience and lower costs.

The survey found 48% of respondents who were mail-order customers had to go without their medications because of late delivery. Those patients who were required by their health plan to use mail order reported much higher rates of late delivery (63%) than those who had a choice of pharmacy (28%).

Patients also reported routinely paying for prescription drugs twice: once for the mail order and a second time at community pharmacies for an emergency fill when the first purchase did not arrive in time. Nearly every patient (85%) left waiting for their medicine by mail reported having this experience. In addition, patients expressed frustration with being forced to purchase a 90-day supply via mail order only to have the doctor write a new or different prescription two weeks later -- leaving the patient with two months worth of unusable medicine.

"These survey results should make employers and other health plan sponsors think twice before imposing a mandatory mail order requirement on their patients," said Bruce T. Roberts, RPh, NCPA executive vice president and CEO. "Mail order programs claim to provide patients greater convenience and lower cost. In fact, patients say they have to wait too long for their drugs and some are paying twice for them.

"Further, mail order is touted as a way to ensure patients stick with their medication therapy. But if deliveries arrive too late or are compromised, patient adherence is severely undermined, not encouraged," Roberts added. "Clearly, Congress should protect the patient's ability to choose where to fill prescriptions in any publicly financed health plan."

As a result of their experiences, 81% of respondents told NCPA they strongly or somewhat oppose a mandatory mail order requirement being imposed on health plan participants.

Mail order pharmacies are owned by the giant pharmacy benefit managers (PBMs), like CVS Caremark, Medco Health Solutions, Inc., and Express Scripts, Inc., hired by health plans to administer drug benefits and negotiate prices. With the authority to set prices for themselves and their retail pharmacy competitors, PBMs routinely stack the deck in favor of their mail order providers and against community pharmacies. It's common for PBMs to charge a plan sponsor a much higher amount than it would a community pharmacy for dispensing the same prescription -- pocketing the difference and passing those higher costs on to health plan sponsors and, ultimately, patients without disclosing them.

To ensure these problems aren't exacerbated by the Congressional health care reform legislative efforts, NCPA is urging that any "public option" health insurance plan be administered by a more transparent and accountable model, such as the pharmacy benefit administrator (PBA) under Medicaid.

To conduct the poll, NCPA officials sent an eight-question survey to pharmacies to display on store counters for patients to complete on a voluntary basis. The survey included an option for respondents to submit brief comments about their experiences. Below are a few examples indicating the survey struck a chord with patients:

Patient #1: "I feel I should have a choice as to where to pick up my meds. Also my meds change quite frequently and mail order doesn't take that into account."

Patient #2: "Multiple times during the year we have not gotten our medications on time. We should not worry when we are going to get our life saving medications."

Patient #3: "The medications that would be mailed must be kept cool. I'm not home often and it would be a major inconvenience to return home just to get medications from outside into the fridge."

Patient #4: "Medicine always seems to be changed from what my doctor wrote."

Patient #5: "My brother gets his meds through the mail and they just leave them outside--Do not knock or ring the doorbell--and two times they said they delivered them--We did not get them."

Patient #6: "I recently received another patient's prescriptions, which I do not take. Still haven't been picked up, but the co-pay was charged to me."

Patient #7: "My insulin has come with chunks of frozen ice floating in the vial - plus in a plastic bag with no support - it is a wonder they did not break. I had to pay for medicine out of pocket ... These are just a few of the things they have done. Mail order should not be mandatory, we should have a choice."

Patient #8: "I have had these medicines delivered and they went to the wrong address and then were opened. Not only would I not take it then due to being opened, my neighbor saw what meds I was taking!"

The National Community Pharmacists Association, founded in 1898, represents the nation's community pharmacists, including the owners of more than 23,000 pharmacies. The nation's independent pharmacies, independent pharmacy franchises, and independent chains dispense nearly half of the nation's retail prescription medicines.