By Chris DePaola, vice president of Cypress Pharmacy
Recent U.S. Postal Service changes have caused delivery delays for mail-order medications, but this is only one issue that can result from mandatory mail-order prescription plans.
For years, Pharmacy Benefit Managers (PBMs) have forced or incentivized patients and employers into mandatory mail-order plans that represent a severe threat to public health and restrict patients’ health care choices.
Locally, some of the area’s largest employers have adopted these mail-order plans, causing employees to involuntarily change pharmacies, sometimes the pharmacy they have trusted for years.
These mail-order plans cause a severe threat to public health in many ways:
- Improper handling. Anyone who has gone outside during a Florida summer knows the impact of heat and humidity. The ideal storage temperature for most medications is between 68 and 77 degrees. Above that temperature, prescription medications can lose potency or could even decompose to form different compounds, some of which could be harmful.
Brick and mortar pharmacies are required to store their medications properly before dispensing, but mail-order prescriptions can be left in a hot mailbox for hours. The time spent in mail transit, especially with current delays, can expose medication to other harsh conditions.
- It’s wasteful. One of the arguments used in favor of mail order is that it saves money. However, medications are often automatically shipped to patients even when they don’t want or need them, and sometimes even after a person has passed away. By law, these medications cannot be returned and must be disposed of, leading to expensive waste.
As a pharmacy that offers medication disposal, we see firsthand the waste generated from mail-order pharmacies. We have disposed of hundreds of thousands of dollars’ worth of mail order waste over the years, and so have our colleagues around the country.
- Lack of proper counseling and medication management. Mail-order pharmacies offer counseling over the phone, but they cannot recreate the relationship built between a patient and a community pharmacist. Your local pharmacist regularly communicates with your physician and knows you, your medications and your regimen. Most importantly, he or she can spot if something isn’t right. For example, say you go to multiple physicians, and they inadvertently duplicate therapies or, even worse, prescribe something that could cause serious interactions.
Your community pharmacist is familiar with your conditions and medications and can coordinate care with your physicians. That level of care and attention isn’t possible with a mail-order pharmacy.
- Conflicts of interest. Most patients are steered into mail-order pharmacies owned or affiliated with PBMs, which are often owned or affiliated with health plans. PBMs are responsible for developing and maintaining the drug formulary, contracting with other pharmacies, negotiating discounts and rebates with drug manufacturers and processing drug claims. Antitrust laws have failed to prevent this unfair competition and predatory practices.
Due to a lack of regulation, formulary drugs are often selected based on the best rebate paid by the manufacturer to the PBM instead of the most effective medication or even the prescription chosen by the patient’s physician. This often means switching medications that a person has been on for years. PBM practices don’t put the needs of the patient first.
- Loss of patient choice. Some patients prefer mail order, but it should be their choice. Unfortunately, it rarely is a choice. Patients are left to deal with dangerous delays, improper medication handling, and inadequate counseling and medication management.
It is time to rethink whether the mail is the best means to deliver medication. Americans prefer freedom of choice and options in the marketplace, and it is time to bring this back to pharmacies.