The Hidden Risks of Mail Order Pharmacies

Mail order pharmacies have made significant inroads in capturing a greater percentage of the drug dispensing business. And, it is a big business. Americans filled approximately 5.8 billion prescriptions in 2018 (a record). With a U.S. population of about 327.2 million, that equates to 17.7 prescriptions per person. Nearly 96% of employers offer a mail order pharmacy option with a health insurance plan. In fact, many insurance plans highly encourage the use of mail order pharmacies and structure their benefits accordingly.

There are benefits to the patient with a mail order pharmacy. Prescriptions are delivered to the patient’s home eliminating the need for the patient to physically go to the pharmacy to drop off and pick up a prescription. In addition, mail order pharmacies typically fill prescriptions in 90-day increments, giving the patient a longer supply of medication. That often helps with patient adherence to taking his/her medication. Finally, mail order pharmacies generally save the insurer money and therefore are less expensive for the patient.

But the news is not all positive. There can be significant drawbacks to the mail order model.

Denials. Because of the managed care aspect of mail order pharmacies, there can be unexpected red tape in the form of insurance and Pharmacy Benefit Manager (PBM) approvals which can lead to initial denials and costly delays of treatment. This is especially problematic for health-fragile cancer or transplant patients requiring expensive drugs.

Delivery Delays. Most mail order pharmacies promise delivery within 7-10 business days. That can be an issue with a new medication or the urgent need for medication when a patient runs out. When time is of the essence, the patient pays the cost in terms of negative health outcomes. According to a survey by the National Community Pharmacists Association, 48 percent of mail-order customers had to go without their medications because of late delivery.

Medication Errors. A mail order pharmacy doesn’t know the patient as a local pharmacist may. This compounds the chance of error when a health care provider mistakenly writes down the wrong medication, dosage, or frequency (about 50% of medication errors). While nurses and pharmacists often catch these errors before the drug is dispensed, a mail order pharmacy is less likely to.

Temperature extremes. Many medications are sensitive to prolonged exposure to high or very low temperatures. Extreme temperatures during shipping or even after a package containing medication is left outside can affect drug potency and effectiveness. Neither the pharmacy nor the patient may be fully aware of how the drug was handled or transported, leading to greater uncertainty.

While a patient might prefer to use a local pharmacy, it’s not always a viable option because of his/her health benefits. Mail order pharmacies are typically owned by the very Pharmacy Benefit Managers (PBMs) who are hired to administer drug benefits and negotiate prices. NCPA officials point out that PBMs attempt to steer insurance plans to mail order prescription fulfillment by charging plan sponsors a much higher rate if a community pharmacy is used. In that same survey, patients required to use a mail order pharmacy (vs. having the option) actually experienced more issues. Small wonder that 81% of the NCPA survey respondents opposed a mandatory mail-order requirement for health plan participants.

Know your prescription options and carefully weigh whether mail order is the right choice. If you do use a mail order pharmacy, be alert to possible delays, errors, and other potential issues. Your health is too important not to.