Do you have your prescriptions filled through a mail-order pharmacy?

You are not alone.

Mail-order pharmacies are an efficient and valuable cost-cutting tool for us and for payers.  Employers increasingly provide discounts for employees to use the lower-cost mail order option, with some employers limiting drug coverage to mail order alone.  Today, one in six companies cover only drugs ordered through the designated mail order pharmacy; the number of prescriptions filled by mail-order houses grew from 222.9 million in 2005 to 237.5 million in 2009.

The battle that is raging between locally owned pharmacies, chain pharmacies and mail-order pharmacies will have an impact on where and when we can get our prescriptions filled in the future.  We can expect that the lower prices offered by mail-order houses will prove irresistible to many of us and to most public and private payers, thereby edging out local pharmacies and perhaps even some of the 24-hour pharmacy services offered by some of the chains.

Consider, however, that many of those who would most likely benefit from the cheaper provision of maintenance medications by mail – the 133 million Americans who make up 45 percent of the working population, and the 90 percent of those over age 65 with at least one chronic illness – face barriers in using such services:

• Many people interact with their mail-order pharmacy by telephone.  One-third to one-half of older people have hearing loss and around 3 million of them have memory problems of various sorts, making it difficult to use automated voice systems required to reach a person to place an order or ask questions.
• Many people interact with their mail-order pharmacy online.  However, people with chronic conditions are significantly less likely to go online, according to a recent study by Pew.
• Add to these the concerns voiced by defenders of local pharmacies: the opportunity for face-to-face counseling, the opportunity to ask questions directly of a familiar and trusted pharmacist, and, of course, the often urgent need for medication for those times when chronic becomes acute.

Fortunately, there are many technological fixes in the pipeline that will help many of us to overcome the practical barriers to online and telephone ordering. 

But what is the plan for the auxiliary back-up system for times when the need for medication is urgent or for those who, for whatever reason, are unable to organize themselves to anticipate the 90-day refills of the five or more drugs they take every day?

Mail-order pharmacies are a brilliant innovation with the potential to significantly cut the cost of prescription medications for us, for our employers and for the government – but the innovation carries with it the unintended consequence of hurting many of those whom it would most likely benefit.

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