NCPA Executive Update

NCPA Executive Update delivers insights on legislative, regulatory, policy, and industry developments from NCPA CEO B. Douglas Hoey, Pharmacist, MBA, to NCPA members and pharmacy leaders every other Friday.

Mail Order Pharmacy Survival Guide | NCPA Executive Update | February 5, 2016

by NCPA | Feb 05, 2016

Dear Colleague,

Doug Hoey

Fortunately, I have not been in the ER—or worse. I'm also fortunate that I am not one of thousands of mail order pharmacy customers who have only seen an empty mailbox because of the recent blizzard that socked much of the East Coast with up to two plus feet of snow.

The snowstorm in the Washington, D.C., area was bad and shut down the region for days. It exposed, once again, the dangers of mail order prescriptions.

I live in suburban Washington and had only one mail delivery in over 10 days—which was a stack of catalogs. Catalogs aren't much help for those patients with diabetes, high blood pressure, multiple sclerosis, etc.

While the storm was severe, most independent pharmacies didn't close or closed for perhaps one day. Here's a picture of a Maryland pharmacy that stayed open in 15 inches of snow.

So, what are all of the patients who are stranded left to do without their medication? You and I both know what they do: they head for their local pharmacy to ask for help until the delivery gets back on track. And, who knows what conditions those medications have been exposed to while they wait to eventually reach their destination. So much for manufacturer storage recommendations!

Question: When you rescue a mail order patient, do you encourage them to contact their employer (including TRICARE) who in most cases coerced them to use mail order in the first place?

Now not all mail order prescriptions are delivered by the U.S. Postal Service. Some are sent via commercial carriers like UPS or Federal Express. No word on their website how many days their deliveries were delayed, but we know that the largest PBM mail order house relies on the U.S. Postal Service. From the Express Scripts website:

Which carrier will deliver my prescriptions?
Most packages are delivered via United States Postal Service (USPS). However, we sometimes use other carriers, including UPS, FedEx and DHL Express.

The number of packages of general goods shipped in the U.S. has never been higher, largely fueled by Amazon. But even Amazon, a company built on a mail order foundation, is losing billions of dollars on the cost of shipping.

In the third quarter last year, Amazon had shipping revenue of $1.5 billion—but had shipping costs of $2.7 billion for a net loss of $1.2 billion on shipping costs alone! How much do those mail order shipping costs add to the cost of prescription drugs—not even counting the waste from auto-shipped prescriptions as seen in NCPA's Waste Not Want Not collection of returned mail order prescriptions?

My point today is not to critique the U.S. Postal Service. My point is that independent pharmacists are highly motivated to be open even when it would be easier or more convenient for them not to be. Independent pharmacies don't have the option of calling in for a "sick day" or "snow day."

What will mail order patients do when their medication delivery is delayed or messed up? The better question is what will mail order patients do without a local community pharmacy around to bail them out not if, but when, something happens to their mail order delivery?

This winter and all year round, keep track of when you've had to be the white knight to help patients when their mail order prescription is who knows where, enduring who knows what temperature and humidity, and tell NCPA by sending your story to Michael Rule at

As for mail order customers in the Washington, D.C., area, hopefully they eventually got something besides catalogs and thought twice about entrusting their health to fair weather deliveries.


Doug Hoey