Controversy stirs over mail-order drugs

In your voice:

If you want to comment about mail order prescriptions or have questions you think Drug Topics should pose to people for or against them, we want to hear from you. E-mail drugtopics@advanstar.com.

Controversy is in the mix after two mail-order prescription surveys with conflicting results were released within two days of each other. A report came from J.D. Power and Associates, released Sept. 17, states that mail-order customers are, on average, happy with service - scoring an 844 on a 1,000-point satisfaction scale.

The J.D. Power and Associates says customers have the same level of satisfaction with mail order as with their pharmacy experiences. The National Community Pharmacists Association released its own report on Sept. 18. NCPA’s survey found “48 percent of respondents who were mail-order customers had to go without their medications because of late delivery,” according to NCPA.

Those patients who were required by their health plans to use mail order reported much higher rates of late delivery (63 percent) than those who had a choice of pharmacy (28 percent). To conduct the poll, NCPA officials sent an eight-question survey to pharmacies to display on store counters for patients to complete on a voluntary basis. The survey included an option for respondents to submit brief comments about their experiences.

Below are a few examples indicating the survey struck a chord with patients:

• “I feel I should have a choice as to where to pick up my meds. Also my meds change quite frequently and mail order doesn’t take that into account.”

• “Multiple times during the year we have not gotten our medications on time. We should not worry when we are going to get our life saving medications.”

• “The medications that would be mailed must be kept cool. I’m not home often and it would be a major inconvenience to return home just to get medications from outside into the fridge.” “Medicine always seems to be changed from what my doctor wrote.”

• “My brother gets his meds through the mail and they just leave them outside-Do not knock or ring the doorbell-and two times they said they delivered them-We did not get them.”

• “I recently received another patient’s prescriptions, which I do not take. Still haven’t been picked up, but the co-pay was charged to me.”

• “My insulin has come with chunks of frozen ice floating in the vial - plus in a plastic bag with no support - it is a wonder they did not break. I had to pay for medicine out of pocket (stet). These are just a few of the things they have done. Mail order should not be mandatory, we should have a choice.”

• “I have had these medicines delivered and they went to the wrong address and then were opened. Not only would I not take it then due to being opened, my neighbor saw what meds I was taking!”

The Pharmaceutical Care Management Association came out against the NCPA survey, saying the two surveys couldn’t both be right.

“One day after J.D. Power and Associates released its national survey, the independent drug story lobby has attempted to undermine it with a release of its own.

“Unfortunately for NCPA, this forces policymakers to choose which source is accurate: America’s foremost consumer research firm or a lobbying organization committed to higher pharmacy costs. Both can’t be right.

“In weighing the facts, policymakers may also want to consider other independent, peer reviewed data showing that mail-service pharmacies dispense prescriptions with more than 20 times the accuracy of traditional brick-and-mortar pharmacies. Furthermore, government studies show that mail-service pharmacies typically dispense prescriptions at lower prices than traditional pharmacies,” PCMA said.

Bruce T. Roberts, RPh, NCPA executive vice President and CEO, released a statement in response to the comment by PCMA. He said, “As the saying goes in business, the customer, or in this case, the patient is always right. Instead of attacking the methodology or attacking us, PBMs should be listening to the patients who are describing the hardships they experience with mail order pharmacies and working vigorously to correct them. Late, misplaced, or damaged deliveries are always inconvenient, but when that occurs with prescription drugs the repercussion for patients can be much more serious. That’s why we remain adamantly opposed to the push for mandatory mail order. It robs the patient of any choice in how they will get their prescription drugs.”

“In addition, medication adherence is a proven best way to improve patient outcomes and reduce costs. That is much more difficult to occur when a patient doesn’t have the face-to-face interaction with their pharmacies in their local community pharmacy and instead are relying on their mail box or a 1-800 number,” Roberts said. The surveys were released at a time when mail order prescriptions are very much in pharmacy’s spot light.

Some organizations are switching to healthcare plans that offer only mail order prescriptions, others have options, and some organizations are dropping the option from their health plans. Several school districts in Ohio have made the decision to only offer mail order prescriptions after two prescription fills. Meanwhile, the health plan offered by State of Ohio’s employees has dropped the mandatory mail order program effective Jan 1, 2010, according to the Ohio Pharmacists Association.

The Ohio Governor’s Office could not be immediately reached for comment. But not all independent pharmacies are seeing relief. Steven Fettman, RPh, independent pharmacist in Canton, Ohio, said his pharmacy, Davies Drugs, will be impacted by the 6,700 Stark County teachers and nonteaching employees who no longer have the option to fill prescriptions more than twice at his pharmacy and have them covered by their health plans.

He said about 65 to 70 percent of his business depends on refills on medications, such as maintenance prescriptions and asthma medication. The new plan administered by Caremark, a pharmacy-benefits manager headquartered in Woonsocket, R.I., and the previous plan’s provider, allows members to fill one original prescription and one refill at the local pharmacy of their choice. Fettman said the issue of mail-order prescriptions is a national one, with an unclear answer to how it helps save money. But proponents have maintained that it does.

According to a story in the Canton Repository, Stark Schools’ move will save a projected $2.25 million annually in seven school districts in Ohio, said Larry Morgan, superintendent of Stark County Schools.

Drug Topics spoke with Caremark spokeswoman Christine K. Cramer and asked specifically, how mail order prescriptions help customers to save money. Cramer offered the following statement: "Because of our unique position, CVS Caremark is able to provide innovative solutions that help meet the health care needs of our customers.  In addition to our traditional mail order pharmacy offering, we provide clients with an option called Maintenance Choice. Maintenance Choice is a completely voluntary offering that is available only if a plan sponsor chooses to participate."

"Maintenance Choice provides plan participants the option of receiving a 90-day supply of maintenance medications used to treat chronic conditions through the mail or in-person at one of our approximately 7,000 CVS/pharmacy stores located across the United States. Regardless of how the plan participant chooses to receive medications, he or she pays the lower mail co-pay and the health plan sponsor pays the lower mail service rate.  For this reason, Maintenance Choice prescriptions are usually less expensive for the participant and for the plan sponsor than prescriptions obtained at other pharmacies." 

NCPA says customers are seeing problems with mail order prescriptions, independent pharmacies are losing a lot of business and some pharmacists have questioned the true savings of mail order prescriptions.

Cramer issued the following statement in response, "If for any reason our mail order pharmacy customers do not receive their shipment of medication on time, CVS Caremark is able to offer them access to a Bridge Supply.  Plan Participants are able to receive a supply of up to five days worth of medication from their local CVS/pharmacy store at no cost, while they await the delivery of their prescription.  The doses provided in the bridge supply are then deducted from their next prescription fill."

“To ensure these problems aren’t exacerbated by the Congressional health care reform legislative efforts, NCPA is urging that any “public option” health insurance plan be administered by a more transparent and accountable model, such as the pharmacy benefit administrator (PBA) under Medicaid,” NCPA said in a recent statement. For the full story on the J.D. Power and Associates study, click here.