Mail Order is Not for Everyone

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As submitted to The Wall Street Journal

Patients and health plan sponsors should use caution regarding recommendations to utilize mail order pharmacies ("Save on Cost of Medication," May 22, 2011).

First, patients not taking their medications as prescribed is estimated to cost as much as $290 billion annually. Face‐to‐face counseling by local pharmacists is two to three times more effective at reducing that amount by increasing patient "adherence."

Second, the appropriate use of generic medications greatly reduces costs, but it is not clear that mail order pharmacies maximize that strategy. Community pharmacies dispense generics 10 to 13 percent more often than mail order. The common practice of employer subsidies to reduce patients' mail co-payments may reduce the patients' financial motivation to switch from expensive brand drugs. And one study found that plans promoting mail with co‐payment incentives paid up to 25 percent more for generic drugs.

Third, as the saying goes, there is no such thing as a free lunch. Plans that reduce patient co-pays to coax mail order usage have to recoup that cost somewhere. Usually, it is passed on indirectly in the form of higher premiums or lower employee compensation.

Fourth, patients enrolled in "mandatory" mail order programs become "captives" to a single mail order pharmacy even if patient care and customer service is poor.

Co-pay gimmicks are no substitute for quality care, real savings and patient choice.

B. Douglas Hoey, RPh, MBA
Executive Vice President and CEO
National Community Pharmacists Association
Alexandria, Va.

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