In the September issue of the Journal of Managed Care Pharmacy (JMCP), Dr. Michael T. Rupp reports on his survey of seniors that documented their concerns regarding mail order pharmacy and outright opposition to mandating its use by patients.
Dr. Rupp analyzed responses from 669 seniors to a survey about their experience with and views on mail order pharmacy. The results were originally announced by NCPA in January.
In his article, Dr. Rupp discusses his findings, including:
- “Many seniors believe they have needs that cannot be adequately met by mail service or have relationships with local pharmacies and pharmacists they believe are important for maintaining their health and well-being.”
- “[M]ost seniors appear to oppose any restrictions on their freedom to use the pharmacy of their choice on general principle.”
- Seniors in rural areas have “significantly greater concerns” due to additional mail delivery issues they face.
Most seniors who were surveyed expressed agreement with a number of concerns about mail order pharmacy. These included running out of medications; lack of face-to-face consultation with a pharmacist; the effects of excessive heat, cold or moisture on medications; waste generated when medications are changed or discontinued; and not getting medications quickly when needed right away.
Moreover, a majority expressed concern that, if required to use mail order, they would lose their freedom to use the pharmacy of their choice as well as no longer have a pharmacist who knows them personally. Seniors were very risk averse about the possible effects of mandatory mail order on the continued financial viability of their local pharmacy. When asked, seniors indicated they would oppose mail order if there were more than a 4-in-10 chance that it could lead to the closure of their local pharmacy.
Rural seniors were particularly alarmed that mandatory mail order requirements could increase the chances of lost or stolen medications; not receiving the exact medication prescribed; and the potential for exposure to extreme weather conditions to degrade their medication.
Dr. Rupp’s article alludes to the open-ended comments that he received, such as from those sharing their own problems with mail order. While individual comments were not included in his September article, some are powerful enough to be worth revisiting, such as:
- “I now am required to use a mail order pharmacy. Service is poor, we travel, they mail it to the wrong address (I give clear and precise directions on where drugs are to be mailed). You never know for sure when or if your drugs will arrive. Long waits on the telephone. Almost impossible to talk to a real person. I much prefer using a local pharmacy or chain pharmacy due to the past poor experiences with mail order.”
- “My rural postal delivery is made to a box 600 ft. from my house. Since delivery times are not consistent, I could not be alert to the prescription arrival. I cannot see the box from my house. I have experienced not receiving my mail order prescription when they were ordered in sufficient time. Thank God for my local pharmacist.”
- “I used mail order for a time. My order was lost. I had to get new prescriptions filled at a local pharmacy. I never received that lost order. I learned later, it went to a city with a similar name. Mail order was not worth the trouble it caused me. At times you need a prescription filled immediately and not have to wait days or weeks to receive it by mail.”
- (Click here for more patient comments.)
Separate research commissioned by NCPA found that 90-day supplies of prescription medications were less expensive for Medicare at community pharmacy than when provided through mail order.
Taken together, the results renew questions about mail order pharmacy inducements or requirements on health plan beneficiaries.