Washington, DC—The American Pharmacists Association (APhA) stopped short of saying, “We told you so,” but issued a press release saying it is “deeply concerned about anecdotal reports of disruptions in the U.S. Postal Service delivery of medications to our members’ patients, including our nation’s veterans.”

“While we are working to independently determine the full extent of these reported interruptions, it is crucial to note that missing medication doses can have a significant impact on a patient’s health,” the APhA states.

The pharmacists trade group reminded that to achieve optimal results, drug therapy much be taken according to the prescribed schedule. It underscored its position that “patients have the right to choose where they obtain their medications, and why we oppose benefit plans and pharmaceutical benefit managers (PBMs) that require patients to participate in mandatory mail order for medications.”

“Time and again, we have seen that an unduly narrow list of medication distribution options courts disaster,” according to the APhA. “Mandatory mail order interferes with the patient–pharmacist relationship. It is important for patients to have a relationship with their pharmacist just like they do with their physician to ensure continuity in care.”

In an issue brief, the Kaiser Family Foundation (KFF) points out that the new Postmaster General instituted changes in the operation of the U.S. Postal Service that could result in mail delivery delays, although those changes have since been suspended until after the November election.

“Potential mail service delays could also be a concern for people who receive prescription drugs from mail-order pharmacies,” the authors write. “In 2019, sales of mail-order prescriptions in the U.S. totaled nearly $145 billion (excluding rebates), with residents of some states more likely than others to use mail-order pharmacies.”

That is a problem particularly during the COVID-19 pandemic, according to KFF, which explained, “Data from the first seven months of 2020 shows that use of mail order increased by up to 20% over 2019 levels in the early weeks of the pandemic as patients stocked up on prescriptions and avoided retail settings, but as of late July, mail-order use is up only slightly compared to the same period last year.”

The brief notes that using mail-order pharmacies can mean more convenience and cost savings, adding that many large group plan enrollees choose to fill prescriptions at reduced cost through the mail, while others are only able to fill scripts at a mail-order pharmacy.

Recent events shine a spotlight on the risks, however.

To understand who may be most affected by delays in the delivery of prescription drugs, the foundation analyzed use of mail order in Medicare Part D and large-group employer plans, identifying the therapeutic classes and specific drugs with the highest volume of fills by mail-order pharmacies in each market.

Based on 2018 data that predates the pandemic, 17% of Medicare Part D beneficiaries (7.3 million) and 13% of large employer-plan enrollees (6.6 million) with prescription use had at least one prescription delivered from a mail-order pharmacy. In total, KFF writes, Medicare Part D beneficiaries and enrollees in large-group employer plans filled 8% and 9% of prescriptions by mail order, accounting for 115 million and 58 million prescription fills, respectively.

Those estimates do not include mail-order use by beneficiaries with other sources of coverage, including Medicaid, Marketplace plans, small-group enrollees, or the Veterans Administration.

Here are some of the findings:

• Across both Medicare Part D and large-group employer plans, cardiovascular agents made up five of the top 10 therapeutic classes in terms of mail-order prescription fills in 2018. 

• Among large employer enrollees, oral contraceptives were among the top 10 therapeutic classes with prescriptions filled by mail order. 

• The top 10 drugs by volume of prescriptions filled by mail order in 2018 were the same for Medicare Part D and large employer plans, though the rankings vary slightly, and include several medications to treat high cholesterol and hypertension. 

• More women than men in both large employer plans and Medicare Part D filled prescription drugs and received at least one mail-order prescription drug in 2018. 

• Drugs used to treat chronic conditions, including hypothyroidism, high cholesterol, hypertension, and type 2 diabetes, are among the prescriptions most commonly filled by mail order for Medicare Part D enrollees and large employer-plan enrollees, whether measured by therapeutic class or product. 

“Therefore, delays in delivery due to changes to the operations of the U.S. Postal Service could lead to negative health consequences if it compromises patients’ ability to adhere to their medication regimens,” the KFF authors write.
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

 « Click here to return to Weekly News Update.