Elimination of Saturday mail delivery could complicate mail-order business

Eighty-eight members of the House of Representatives fired off a letter Monday to postmaster general and CEO of the U.S. Postal Service Patrick Donahoe urging the agency not to eliminate Saturday delivery of mail, saying it would impede the ability of people who depend on mail-order pharmacies to receive their medications.

It's no secret that the retail pharmacy industry and pharmacy benefit managers don't always see eye-to-eye, with the latter being the main provider of mail-order pharmacy services in the country and often touting them as an alternative to going to the drug store, while the former emphasize the face-to-face interaction with pharmacists not usually possible with mail-order. But between the back-and-forth, millions of patients still depend on mail order pharmacy, and the cost effectiveness that mail-order pharmacies frequently promote themselves as offering could be at risk if they must use more expensive delivery methods.

Many patients don't have the option of going to pharmacies because of old age, disability or because they live in isolated, rural areas without convenient access to a pharmacy. In 2009, CVS Caremark delivered 50 million prescriptions through the mail, according to an op-ed by SVP mail pharmacy operations Kenneth Czarnecki that appeared in the Chicago Tribune in 2010. For many of those patients, particularly those living with chronic conditions and disease states that require precisely timed dosing, running out of medication and missing doses could have serious, long-term consequences.

As an alternative to shutting down Saturday delivery entirely, the representatives suggested exempting medications and allowing them to continue to be delivered then. Barring that, however, mail-order pharmacies would be forced to either make do with a five-day schedule or, the representatives wrote, use other, possibly more expensive delivery methods.

That could be a problem for a channel that has long promoted itself as a cheaper alternative to brick-and-mortar pharmacy retailers. In late 2012, specialty pharmacy patients - most of whom had conditions like HIV, cancer and autoimmune disorders - covered by Anthem Blue Cross started receiving letters from the insurer stating that their drugs would only be covered if they obtained them through CuraScript, Express Scripts' mail-order specialty pharmacy business. A spokesman for Anthem told Drug Store News at the time that the move was intended to cut costs, though specialty pharmacies that had treated the patients balked, saying it would threaten continuity of care. In addition, according to experts, missing doses of some drugs, such as those that treat conditions like HIV, can cause the virus to become resistant to them.