Northeast Pharmacy Service Corporation
Mail Order
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Mail Order Resources
Mail order pharmacies have been filling three month prescriptions through insurance plans as a convenience for more than thirty years. More recently companies are being persuaded to require that all prescriptions for continuing, long-term therapy be filled in mail order pharmacies. The local pharmacy, the community and the state are all losers in the transaction. Employers might not even realize savings. For the largest PBMs that own their mail order pharmacies, this a very profitable segment of their business.
For patients, there are safety, security, waste, and timing concerns. In addition, some prescriptions for generic medications are more costly in mail order than they are at the local pharmacy. It might be time to give this some more thought.
In support of the discussion that follows, here are important reference materials:
“Examining the Value of Pharmacy Benefit Management Companies”, Garis RI, Clark BE, et al. Am J Health-Syst Pharm 61(1):81-85, 2004.
http://www.medscape.com/viewpublication/74_toc?vol=61&iss=1
“Comparing Pharmacy Benefit Managers: Moving Well Beyond the simple Spreadsheet Analysis”, Calabrese D, Am Hlth Drug Ben 1(5):9-19, 2008
http://AHBDonline.com/docs/calabresejune.pdf
“Comparison of Mail-Order with Community Pharmacy in Plan Sponsor Cost and Member Cost in Two Large Pharmacy Benefit Plans”, Johnsrud M, Lawson KA, et al. JMCP 13(2): 122-134, March 2007
http://www.amcp.org/data/jmcp/p122-34.pdf
“The Spread: Pilot Study of an Undocumented Source of Pharmacy Benefit Manager Revenue”, Garis RI, Bartholomew EC, J Am Pharm Assoc 44(1): 15-21
http://www.medscape.com/viewarticle/469844
“Generic Drugs by Mail Can Be a Raw Deal” Martinez B, WSJ, February 15, 2005:B1
http://webreprints.djreprints.com/1171401366630.html
“Mail-Service Pharmacy Savings: A Conclusion in Search of Evidence” Carroll NV, JMCP 12(2): 164-166, March 2006
As expensive as healthcare coverages are to employers, promised savings can be a big enough lure for them to move into a mandatory mail order program. What is clear are unit cost discounts that are steeper in mail order. But little is actually known about the bottom line results. Further, unit cost discounts might create savings in year one, but they don’t change the rate at which the benefit increases in cost from year to year. In fact, the elimination of one month’s copay from mail order prescriptions could fuel higher utilization and increase costs at higher rates than would have occurred.
Mail order prescriptions will never replace community pharmacies; there will still be local pharmacies to provide the medicines that patients need now, i.e. antibiotics, analgesics, anti-nauseants, etc. The question is should patients be forced to fill their prescription through the mail? Should local pharmacies be allowed to provide prescriptions in convenient 90-day quantities when the patient elects?
Waste costs money and contaminates our water and environment. Is waste increased or decreased by mail order? How does that affect cost? What will the eventual price tag for waste disposal be?
Safety: What’s the temperature in your mail box? Are there any storage requirements for your medications? Between the mail order pharmacist and you, who else touches your medication? Is that what you call a supply chain?
Solution: Let community pharmacies provide convenient 90-day supplies so they can continue to provide care for their patients. Give patients the choice.