Mandatory mail-order jeopardizes pharmacy patients

December 15, 2009

Dec. 12, 2009
By JOSEPH H. HARMISON
Special to the Star-Telegram

Like other forms of medicine, pharmacy has the privilege of being among the most ancient professions. It’s been a regulated health service since at least 1235 in Europe. 

Almost everything in medicine has changed since scribes in the Middle Ages recorded the work of those first pharmacists. 

Most changes have been good. We are grateful that the practice of using leeches has ended. Yet, there are also practices many of us miss, like physician house calls. 

One constant is the presence of a neighborhood pharmacist in almost every town, village and city. Time has not erased the need for highly trained medication experts to whom patients can turn for advice on the dosage, side effects, interactions and cost of medicines. 

There is an effort afoot to make this relationship as obsolete as the house call. 

Those who would benefit financially from requiring patients to order their drugs by mail are pushing this effort — giant pharmacy-benefit managers, or PBMs, such as CVS Caremark, Medco Health Solutions and Express Scripts, which collectively reported a 20 percent profit increase last year alone. They seek even greater profits on the backs of patients and community pharmacies by mandating the use of their own mail-order pharmacies. 

PBMs are hired by insurance companies to handle the drug part of health insurance plans and to negotiate prices with drug companies. This arrangement allows the PBMs to set prices for themselves and for their retail pharmacy competitors. PBMs are stacking the deck in favor of their mail-order pharmacies and against community pharmacies. 

Supporters of mandatory mail order use cost as their primary rationale. But these claims of savings are wildly exaggerated. 

To date, not a single peer-reviewed study proves such large-scale cost reductions exist. The studies that do exist come from the mail-order pharmacies themselves, allowing these companies to cherry-pick the data that lead to their desired result. 

In fact, mail-order pharmacies are often more expensive for employers, insurance providers and patients. 

The problem stems from mail-order pharmacies receiving large rebates from drug companies for steering patients to certain drugs, leaving employers and consumers forced to buy more expensive drugs even when cheaper ones are available. 

It’s also common for PBMs to pay their own mail-order pharmacies more than they would pay a community pharmacy for dispensing the same drugs. 

Then the PBMs pocket the difference and pass the higher costs on to the employer providing health insurance. Those undisclosed costs are ultimately passed on to the patient. 

Another compelling reason to stop the push for mandatory mail-order is quality of care. 

A recent J.D. Power study found that patients were more satisfied with independent community pharmacies such as Health Mart and the Medicine Shoppe than mail order. Patients also gave the big three PBMs (CVS Caremark, Express Scripts and Medco) mediocre mail-order ratings. 

A survey by the National Community Pharmacists Association showed specific problems. Patients said their drugs did not arrive on time, forcing them to pay twice — once for the mail order and a second time at a community pharmacy for an emergency fill. 

Some mail-order patients said their drugs were delivered to a neighbor, revealing intimate details of the patient’s medical history. 

Others said their prescriptions change too often for mail order to keep up, forcing payment for a 90-day supply when new prescriptions are needed after 30 days. 

Your pharmacist should be more accessible than your cable company. Imagine the frustration of being routed through an automated phone system to get advice on a medication that can mean the difference between life and death. 

Currently, the right to instant, face-to-face conversation with a highly educated medical professional is guaranteed each time you walk into your pharmacy. 

By stopping the push to mandatory mail-order pharmacies, we guarantee that this ancient right will be preserved for another 800 years. 

Joseph H. Harmison is president of the National Community Pharmacists Association and owns Harmison Pharmacies in Arlington.

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