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Mail-Order Pharmacy Woes

Even as more and more of us are forced by our health-insurance plans to fill prescriptions through the mail, a new survey finds many consumers have gone without medications because of delays. And that's not the only problem the survey turned up.

The Alexandria-based National Community Pharmacists' Association (NCPA) -- admittedly not an unbiased source -- created a questionnaire featuring eight questions about people's experience with mail-order pharmacies and left in on pharmacy store counters for customers to fill out. Of the 400 surveys collected, nearly half of the respondents -- 48 percent -- reported they had missed taking medications because they were delivered late. And a whopping 85 percent reported having to pay twice for medications -- once when they placed their order and again when they had to run to the pharmacy for an "emergency fill" when the mail-order meds didn't arrive in time.

Another commonly reported problem stemmed from mail-order pharmacies' requirement that prescriptions be written for 90-day supplies; patients said they'd been stuck with medicines they couldn't use after their physicians had them switch medications before the 90-day supply was used up -- sometimes after just two weeks.

Mail-order Rxs are supposed to offer convenience and save money, but the NCPA survey reveals that in many cases they do neither.

The survey also allowed respondents to write their own comments about their mail-order prescription experiences. In addition to problems with packaging and leaving medications unattended outside recipients' doors, one person wrote that medications had been wrongly delivered to a neighbor, who opened them. The respondent said he (or she) couldn't then use them because they'd been opened and noted that "my neighbor saw what meds I was taking!"

If all that sounds grim, another pharmacy organization with a much bigger survey released just about the same time as the NCPA poll found people much pleased with their pharmacies, even the mail-order variety, which won a 834-out-of-1,000-point rating. Read the full report from the survey conducted for the Pharmaceutical Care Management Association here.

How do you feel about mail-order pharmacies? Any horror -- or success -- stories to share?

By Jennifer LaRue Huget  |  September 21, 2009; 7:00 AM ET
Categories:  General Health , Health Policy  
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Comments

"a questionnaire featuring eight questions about people's experience with mail-order pharmacies and left in on pharmacy store counters for customers to fill out" is poor statistical procedure.

For example, I am happy with my mail-order pharmacy and so never go to pharmacy counters. The only folks likely to find and fill out those forms would be those unhappy with mail-order pharmacies or those who do not use them.

Posted by: Bartolo1 | September 21, 2009 8:27 AM | Report abuse

It's pretty poor -- and biased -- journalism to ADMIT that a study was performed by a group that has an economic stake in finding poor service from mail-order pharmacies -- and which was not professionally performed in any event -- and then use that for an article recounting (and requesting) horror stories about such pharmacies.

Why don't you ask for stories about how CVS has given out wrong medications, has been out of supply of needed medications and then told me 3 days in a row that they would have it the next day, and then misbilled me to boot?

Doesn't THAT fit your political agenda that the big, bad health insurance companies are killing us?

Posted by: WashingtonDame | September 21, 2009 9:00 AM | Report abuse

I'm on Medicare Part D. What I discovered was that dealing with local retail stores was THE most expensive way to buy medications. Second best was to buy from a mail order service. I later discovered that the mail order service was a wholly owned subsidiary of the insurance company. Their prices were somewhat cheaper, but they controlled the prices, so that the co-pays only increased once a year, but the "retail" prices (counted as part of the True Out of Pocket Cost) slowly but inevitably pushed me into the "donut hole" within 6 months and I had to pay their full price, which was by then well beyond my ability to pay.

After a bit of research, I found that I could buy the same meds at a local big box store -- at half the price, without insurance. My state has a minimum markup law, so they were still making a comfortable profit on medication sales. The other half of the mail order service's profits obviously was being used to subsidize the obscene salaries of the insurance company's executives. In short, I would have been better off without Medicare Part D insurance!

Posted by: sbirchall | September 21, 2009 12:08 PM | Report abuse

Well, my experience supports the survey. I sent my paper prescription in to MEDCO after receiving it from my doctor after my annual physical exam. Tho it was a 90 day prescription, refillable 3x to cover the year til the next visit--and was an ordinary hormone replacement drug not anything narcotic--they only filled it for one month and notified me I'd have to take their paperwork back to the doctor and have her FAX the long-term prescription in! Unbelievable! When I get the new paper prescription, you can bet I'm taking it to CVS or Giant where I don't have to deal with this nonsense.

Posted by: commonsense101 | September 21, 2009 12:16 PM | Report abuse

My wife's and my experiences with Medco have been far different than commonsense101. We've dealt with them for maybe 12-15 years. I can order renewals online. If I order when I have about 2 weeks of meds left, I get them in plenty of time. Always had excellent service. The only "regret" I have is that I didn't buy their stock.

Posted by: Rocketman1 | September 21, 2009 1:23 PM | Report abuse

I had real privacy problems with Medco. I take a med for a chronic condition. One day I get a call out of the blue from a pharmacist at Medco who wanted to discuss my medications. He said they had reviewed my records and suggested I substitute X drug for Y. I told him it was none of his business and that he was practicing medicine w/o a license. There was also no effort to verify my identity (anyone could have picked up the phone -- it was an office number -- and said they were me).

A year earlier they had sent me a letter suggesting I switch from x to y. My assistant opened it (no "Confidential" stamped on it) as she opens all my mail.

Frankly, I am offended that Medco plays so fast and lose with my personal medical information.

As for on-time delivery, try getting them to deliver a med that needs refrigeration to South Florida. My company requires we use Medco but the hassle factor is beyond belief: scheduling, having someone at the house mid-day (or scheduling a run to an inconvenient UPS site) $100 saved in costs, but $200 lost in worker productivity and aggravation.

So yeah, Medco is OK for long-term routine drugs, but anything special, not so good. And forget about privacy.

Posted by: alonzoQuijana | September 21, 2009 1:44 PM | Report abuse

Being a pharmacy student currently interning at a community pharmacy, and having at one point purchased my prescriptions via mail-order, I can tell you mail-order is a mixed bag. If you (the patient) are able to manage your own medications (get them in to be refilled on time, aware of refills, keeping on top of expired Rxs and getting new Rxs from MDs, etc), then mail-order can be a good option. I never recommend mail-order to elderly patients or patients with cognitive impairment - mail order is often too complicated for older patients on multiple medications, and for patients with cognitive impairments. Also, patients with complicated medication regiments (complicated high blood pressure, congested heart failure, dementia, diabetes, certain mental disorders, etc.) frequently need a personal interface with their patient to ensure medication adherence, prevention/mediation of side effects, and manage frequent dosage/drug changes.

Granted, this survey WAS conducted by an organization with a vested interest in diverting business from mail-order. However, for a large number of patients, mail-order is not the ideal way for them to purchase their medications, and should not be mandatory or required by drug insurance plans.

Posted by: studentkt | September 21, 2009 1:55 PM | Report abuse

I am retired military and so my wife and I get most of our meds through mail order but for short term of one time meds, the corner pharmacy. We reorder via the internet, get an acknowledgement back, and receive the meds usually in less than 5 days. For anyone who takes the same meds for long periods of time, BP or cholesterol, etc, mail order scrips are great.

Posted by: melj1 | September 21, 2009 1:58 PM | Report abuse

I have used three different mail order pharmacies over the past three years. The first year I used ExpressScripts through my COBRA coverage and I had few problems. The mail order was cheaper than using my local CVS. When my Medicare kicked in, I elected Humana as my part D provider. I was not impressed by their mail order pharmacy (Right Source). I found their website was not user friendly and also only worked in Windows (which is not indicated anywhere on their site, but I eventually found that out). My problems with Humana were not just with their mail order pharmacy in that their benefit statements were usually months behind in their information. I switched to Medco this year based on my parents' positive experiences with them for years. I have no problems with Medco and find their website easy to use (and I can access it from my MAC). Like rocketman, I order my refills online and I like the fact that you can order the refills early and they will process the order as soon as the time is right. They email you refill reminders and when they have shipped your order. For my particular meds, mail order is much cheaper than the local CVS. In short, when open season comes up in two months, I will not be switching.

Posted by: onthewaterfront | September 21, 2009 2:13 PM | Report abuse

We use Kaiser's mail pharmacy, for refills, and for medications you take regularly it saves time because you don't have to go to the pharmacy and wait. They don't require a 90 day prescription and will handle the doctor's re-authorization so it's easy.

My MIL had Medco and it was a problem for her. She was someone who didn't think ahead too effectively -more a personality trait than a sympthom of old age- and she'd run out of medications and end up in bad shape.


Posted by: RedBird27 | September 21, 2009 2:23 PM | Report abuse

News flash: brick-and-mortar pharmacies claim that those new-fangled mail-order pharmacies aren't as good. Film at 11.

Also: you'd think that having a 90-day supply of medecine is a *good* thing. Don't people realize that it's wise to have more than a couple days' supply of the drugs that are keeping you alive? Doesn't anyone remember Katrina? Or do we think "it can't happen here?"

Finally: if mail-order really was less cost-effective across the board, would the insurance companies be forcing you to do it? An anecdote here and there isn't persuasive.

Posted by: DupontJay | September 21, 2009 4:00 PM | Report abuse

Pretty harsh WashingtonDame. It was an admittedly unscientific survey but pushing an agenda?? Geez, get over yourself.

I've had a few issues with my mail-order vendor. Once they left a voice msg on a public voice mail at my office about my prescription order. Nothing confidential but they really should know better. Another time I was trying to get them to replace the child-proof caps they provided with regular ones and they just refused - said they COULD NOT send me just caps without a refill. It escalated until I got a supervisor to accommodate and even gave me a $40 credit for my troubles. Nice gesture but then they failed to apply the credit with my next order. Admittedly these are essentially service issues but could just as well have been med issues, and the fact that they knew I am the benefits manager where I work did not induce them to try any harder to make me a happy customer.

With generics and alternative sources for 90-day refills such as Wal-Mart mail-order is no longer the only way to go. It's very convenient and does provide a savings but it can be difficult to resolve problems without a face-to-face relationship with a pharmacist.

Posted by: PosterGuy | September 21, 2009 6:03 PM | Report abuse

This article is flawed and misleading. The writer and the survey respondents miss several points:

1) You are not supposed to opt for the 90 day prescription until there is evidence it is working for you. Typically you are allowed three refills before being required to used mail order. Mail order is not for one time use prescription.

2) Some issues such as pre-certification are not required by the mail order pharmacy, but the prescription plan owner (i.e., your employer.)

3)I have never received a late prescription that I did not order (reorder late). Medco is very good at telling you when the next refill is due.

4)The one minus I find is that like many service providers today, mail order pharmacies use automatons in customer service. They are there to create an access firewall and the representatives either don't have the ability or permission to think and act independently from the company script.

Posted by: jsump | September 21, 2009 6:20 PM | Report abuse

My insurance basically forced me to take mail order meds when they suddenly decided that my neighborhood pharmacy-- a small business, not part of a chain--was not good enough to fill the same prescriptions that CVS and Giant screw up all the time. I HATE mail order meds. It is not more convenient for me, does not save me any money--it costs the same, and risks my privacy. I'm still trying to figure out why this is supposed to be so convenient for me.

Posted by: PepperDr | September 21, 2009 8:34 PM | Report abuse

Might want to do some valid research and check out the most recent JD Power consumer satisfaction results for Pharmacy from an actual reputable organization (http://www.jdpower.com/corporate/news/releases/pressrelease.aspx?ID=2009166). Mail Service pharmacy dominates all community pharmacies in their survey when it comes to service...

- Mail-order pharmacies: 834
- Supermarket pharmacies: 820
- Mass merchandiser pharmacies: 801
- Retail chain pharmacies: 798

Posted by: scottg6 | September 21, 2009 11:01 PM | Report abuse

MedCo is terrible. I had to deal with them for several years and they were always late shipping, misplaced orders, required me to get emergency refills, etc. I have now been switched to PrescriptionSolutions, with is actually part of MedCO but apparently centers on chronic prescriptions. Now I can no longer get 90 day supply (because of the price and the chance my doc may change the prescription. Mail order is great when it works, but a disaster when there is a problem. Generally their customer service is terrible as no one really knows anything and their web sites never work correctly.

Posted by: mdembski1 | September 24, 2009 4:09 PM | Report abuse

Mail-order pharmacies do not create local jobs. I see no reason why I can't go down the street to a local pharmacy and simple refill my presecription.
I have had such quality problems with generics from the mail-order pharmacy our insurance insists on to the point where I have my doctor write script for brand-name drugs at all times. I pay extra for this, but its only way I can be sure I get the doseage prescribed.

Posted by: treadlefish | September 24, 2009 9:39 PM | Report abuse

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