Debate Over Mail-Order Prescription Drugs Heats Up

A proposal by the US Postal Service to cut Saturday mail delivery has sharpened the divide between community pharmacies and pharmacy benefit managers.

As the US postal service (USPS) scrambles for solutions to its growing financial crisis, one proposal that could save the agency $3 billion is facing intense scrutiny from opposing groups within the pharmacy industry.

Pending congressional approval, USPS plans to eliminate Saturday delivery in fiscal year 2011. By switching to a 5-day schedule, it hopes to create a “leaner, more flexible Postal Service”—and to cope with fallout from the $7 billion revenue drop that occurred in fiscal year 2009.

The stakes are especially high for pharmacy benefit managers (PBMs), the entities that manage the prescription drug plans of more than 210 million Americans. PBMs rely heavily on mail-order pharmacies, which they argue improve adherence and minimize costs.

In an effort to increase patient uptake of mail-order prescriptions, many PBMs have imposed mandates or offered lower copays for drugs ordered by mail. These practices have been criticized by community pharmacists, who view mail-order pharmacies as poor substitutes for the personalized medical attention of a neighborhood pharmacist.

The philosophical divide was brought into sharp relief recently, when both the National Community Pharmacists Association (NCPA) and the Pharmaceutical Care Management Association (PCMA), a group that represents the nation’s PBMs, issued statements that zeroed in on the patient care implications of a 5-day mail schedule.

“Consumers count on getting their prescriptions at the right time and shouldn’t be made to wait 2, or in the case of federal holidays that fall on a Monday, 3 days,” said Mark Merritt, PCMA’s president and chief executive officer.

Douglas Hoey, RPh, acting executive vice president and chief executive officer of the NCPA, called this concern “overblown.” If anything, he argued, the change would improve public health by offering more opportunities for independent pharmacists to deliver specialty services, such as home delivery.

“Patients overwhelmingly prefer the face-to-face interaction with their local pharmacists, who can improve medication adherence. So measures that allow this to occur more often will help create better health outcomes,” Hoey said.

In a letter to Ruth Goldway, chairperson of the US Postal Regulatory Commission, Hoey recommended private market solutions that focus on eliminating mandatory mail-order programs and encouraging the use of home delivery. The service is already offered by 81% of independent community pharmacies, according to an NCPA study.

In a press release accompanying the letter, Hoey offered reassurance that the switch to a 5-day schedule would not significantly impact patient access to prescription drugs.

“If the leadership of the US Postal Service determines that budget shortfalls require fewer delivery days, they should understand independent community pharmacies are ready and willing to offer their assistance,” he said.

For other articles in this issue, see:

  • Louisiana Pharmacist Leads the Way for Medication Therapy Management
  • Health Plans to Provide Free Preventive Care
  • Study Links Plastics Chemical to Polycystic Ovarian Syndrome