Mandatory Mail Order Debate Rages On


By Kevin Schweers

Drug Topics recently published a thoughtful, 1,900 word examination of the pros and cons of mail order pharmacy.

Drug Topics’ Fred Gebhart deftly covers the sincere arguments offered by all sides of the mail order debate. Two academics and an oncology expert told him that mandatory mail order policies that block or severely restrict patient access to community pharmacies are a bad idea – a view NCPA strongly seconds.

Two passages from the article illustrate the intransigence of some pushing compulsory mail order and how many patients react.

Excerpts from the Drug Topics article, available in its entirety here, follow below. It’s worth noting that most independent community pharmacies provide home delivery services, often free of charge.

“Independent pharmacists are concerned about mandatory use of mail order, too. It takes patients away from their stores. Mail-order programs backed by heavy incentives are just as bad, said Melvin Musgrove, owner of Tower Medic Pharmacy, Fort Worth, Texas.

“‘Getting a 90-day fill for a 30-day copay is a powerful incentive’, he said. ‘Most independents would accept that arrangement, but we are not offered that opportunity. I don’t like it, and my patients don’t like it, but they don’t have a realistic alternative.’

“But Musgrove doesn’t have to use mail order himself. He recently dropped prescription coverage from his employee health program, written through Principal Insurance and administered by Caremark, a PBM owned by the CVS drug chain. He told Drug Topics that Principal and Caremark declined to allow pharmacy employees to fill their prescriptions locally instead of using a mail-order program even after Musgrove offered to accept the same terms as those covering mail order.

“‘I elected to drop prescription coverage and went to filling employee scripts at cost,’ Musgrove said. ‘It’s more expensive for me, but filling scripts today is better for my employees than waiting 10 days, 2 weeks, for a mail fill, if it comes at all. And it’s good to tell the insurance company where they can stick their insistence on mail.’”
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“Consumer satisfaction consultants J.D. Power and Associates agree. A 2009 survey released earlier this year found that pharmacy customers are highly satisfied overall, said Jim Dougherty, director of healthcare practice, J.D. Power and Associates, Westlake Village, Calif. Mail-order satisfaction measured 834 out of a possible 1,000 compared to 815 for brick-and-mortar pharmacy and 798 for chain pharmacy. Independents topped them all at 869. A difference of 8 to 14 points is statistically significant, he said.

“‘Service trumps price across the board for consumers,’ Dougherty said. ‘In the independent pharmacy experience, the person behind the counter knows your name. That trumps a lower price.’

So why do mail-order customers stay? Some programs, including Kaiser Permanente and the Veterans Administration, offer mail as an alternative, not a mandate. When customers have a choice, some prefer mail for convenience or consistency of service. Customers who don’t have a choice about using mail order are unhappy. Fully 61% of mail-order customers surveyed by J.D. Power and Associates are locked into the program by mandates or differential copays. They are ready to escape at the first opportunity.

“‘They aren’t loyal customers,’ Dougherty said. ‘They’re hostages, and they don’t like it.’”

3 Responses to “Mandatory Mail Order Debate Rages On”


  1. 1 Jim Fields RPh August 9, 2011 at 4:37 pm

    PBMs don’t make the decision on whether health plans use mail-order, mandatory mail or retail pharmacy. Payers (employers and HMOs) are given the “freedom of choice” to choose whatever style of drug distribution system they want for their employees or clients.

    They may choose retail, mail order, a combination of the two, differing co-pays, and so on. The PBMs then act as the traffic cop enforcing the speed limit. The cop does not set the speed limit nor does he care whether the speed limit is 55 or 75 miles per hour. Whatever the state lawmakers and private payers “choose,” the cop will enforce the limit.

    However, todays PBM business model is ineffectual and are actually corrupt policemen, corrupt in that they have incorrectly informed the “choosers” of the virtues and values of mail order and AWP discounting. But pharmacy is also to blame for their inability to market successfully the virtues of a point-of-service (POS) drug distribution system against the PBMs’ marketing of mail order.

    I have sat on advisory panels while pharmacy complained about the unfairness of mail order but they never presented a business plan that countered the PBM argument that a bigger AWP discount was better and mail order was even better yet. IN THE WORLD OF MONEY… NO PLAN…. NO BUSINESS.

    Pharmacy should not look for a political solution for this particular problem. Just present the facts that POS drug distribution is more patient friendly, cheaper, has better health outcomes than mail order, and of course have the facts to prove it.

    ApproRx will do an analysis on any Mail Order account and show that all the above postive statements regarding community pharmacy are true, do an analysis; not words, not politics, just the facts.
    Jim Fields RPh CFO ApproRx


  1. 1 About those Mail Order Savings « NCPA's The Dose – The Voice of the Community Pharmacist Trackback on May 14, 2010 at 3:18 pm
  2. 2 Bringing Congress to Community Pharmacy « NCPA's The Dose – The Voice of the Community Pharmacist Trackback on May 26, 2010 at 1:57 pm

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