Survey: 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 conducted by the National Community Pharmacists Association.

The NCPA says the findings raise 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 of more than 400 patients found 48 percent of respondents who were mail-order customers had to go without their medications because of late delivery. Those patients who are required by their health plan to use mail order reported higher rates of late delivery (63 percent) than those who had a choice of pharmacy (28 percent).

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NCPA officials say patients also reported routinely paying for prescription drugs twice – once for the mail order and a second time at a community pharmacy for an emergency fill when the first purchase did not arrive in time. Eighty-five percent of patients left waiting for their medicine by mail reported having this experience.

According to the survey, patients are frustrated 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, the NCPA's 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.

According to Roberts, if mail order drug deliveries arrive too late or are compromised, patient adherence is undermined.

"Clearly, Congress should protect the patient's ability to choose where to fill prescriptions in any publicly financed health plan," he said.

Eighty-one percent of survey respondents told the NCPA they strongly or somewhat oppose a mandatory mail order requirement being imposed on health plan participants.

Mail order pharmacies are owned by large pharmacy benefit managers (PBMs) like CVS Caremark, Medco Health Solutions, Inc., and Express Scripts, Inc., which are hired by health plans to administer drug benefits and negotiate prices.

NCPA officials claim that PBMs routinely "stack the deck" in favor of their mail order providers and against community pharmacies. The association says PBMs charge a plan sponsor a much higher amount than they would a community pharmacy for dispensing the same prescription – "pocketing the difference and passing those higher costs on to health plan sponsors and patients without disclosing them."

Roberts said the NCPA wants to be sure 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.