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.’”
“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.’”