Corner Drugstore Comes to the Mailbox : New Surge of Pills-by-Post Pharmacies Generates Controversy
Julian Wilson of Inglewood used to buy his high blood pressure medication from the drugstore. But earlier this year, he began ordering it from a new, Chatsworth-based mail-order pharmacy and says he’s hooked on the new service.
“It saves me time and money,” said the 71-year-old part-time security guard. “I used to stand in line (at the drugstore) 15 or 20 minutes. Now, I mail in the prescription from my doctor and get it (the medicine) sometimes the next day. On the average I save $40 a month.”
Twice as Many Companies
Pills-by-mail operations such as the one Wilson uses have more than doubled since 1981, but they have not undergone this surge without controversy.
Mail-order pharmacies aren’t a new concept. The American Assn. of Retired Persons, for instance, included mail-order drug service as part of its membership package when it was founded 27 years ago.
But now, other organizations--including two new Chatsworth-based operations, ElderMED Mail Order Pharmacy Service and CliniShare Direct Rx--are getting into the act.
Walgreen in Market
Major drugstore chains, including the Walgreen Co., operator of 1,300 retail drugstores, have entered the mail-order market, too.
“There has been major growth in mail-order pharmacies in the last year or year and a half,” said John McHugh, president of the National Assn. of Mail Service Pharmacies, a Virginia-based trade association of seven mail-order pharmacies. Five years ago, only about 10 mail-order pharmacies operated nationwide, five of them major operations, said McHugh, who also serves as president of the AARP Pharmacy Service. Today, he estimates, there are about 25 across the country, and about nine of them are major operations.
Of the estimated 1.5 billion prescriptions filled in the U.S. annually, McHugh said, about 60 million, or 4%, are now filled by mail order.
Not everyone is enthusiastic about mail-order pharmacies, however. Five states--Georgia, Michigan, Minnesota, North Carolina and Oklahoma--prohibit mail-order pharmacies from locating within their borders, said Nicholas Willard, director of governmental affairs for the AARP Pharmacy Service. Four states (Alabama, Arkansas, California and Louisiana) require out-of-state mail-order pharmacies to have state pharmacy permits (licenses) before shipping into that state, he said.
The constitutionality of requiring mail-order pharmacies to obtain a license in each state in which they do business is currently under debate in several states. Operators of mail-order pharmacies claim that the requirement is unconstitutional and so costly that it will eventually drive up prices. This year alone, according to Willard, out-of-state licensing proposals have failed in nine states.
Those who favor the licensure requirement, on the other hand, say their sole concern is the health and safety of the public and that licensing of out-of-state mail-order pharmacies will help ensure that. One issue of concern, according to Lorie Rice, executive officer of the California State Board of Pharmacy, is that patients have “proper avenues for consultation (with pharmacists). Our bottom line is the issue of consumer protection.” (Some mail-order pharmacy operators say such consultation is available by phone.)
Edwin L. Kramer, a pharmacist at Jay Scott Drugs, an independent Burbank pharmacy, believes mail-order pharmacies can’t provide the public with the kind of “intimate contact” with a pharmacist that drugstores can. “The most important facet of the pharmacist is to be a consultant,” he believes. “Especially with older people, there are so many chances of drug interactions. We’re (drugstore pharmacists) the first line (of information about medication) for a patient. They come to us if they have any questions about medications.” That type of communication, Kramer says, can’t be carried out successfully by phone.
Face-to-Face Counseling
Also opposing mail-order pharmacies is the California Pharmacists Assn., according to Victor Boisseree, vice president for professional affairs for the Sacramento-based organization that includes 7,000 hospital, chain store, independent and other pharmacists. “We believe they are not in the best interests of the patient,” said Boisseree in a telephone interview. “We have existing policy that the pharmacist should counsel the patient on a face-to-face basis” if possible. “We are developing a campaign that will provide material to (our) pharmacists to advise their patients as to the dangers of using mail-order prescription services.”
Despite the debate, proponents of mail-order pharmacies are confident that the services will continue to grow. Most of the mail-order pharmacy services, McHugh said, are marketed to employers or associations such as AARP, which in turn offer them to their employees or members.
Convenience is one impetus for the growth of mail-order pharmacies, designed to fill consumers’ need for non-emergency prescription and over-the-counter medications. Consumers too busy or too frail to wait in line at the local pharmacy can obtain prescriptions simply by mailing in their order form--provided they plan ahead sufficiently to allow enough time for delivery. Consumers with chronic medication needs for such ailments as high blood pressure, arthritis and heart conditions are among the best customers, say operators of the mail-order pharmacies, although orders vary.
“Our prescriptions pretty much run the gamut, ranging from antibiotics to painkillers,” said David Chang, the pharmacist for the CliniShare Direct Rx and Elder-MED Mail Order Pharmacy Service.
Cost savings are another major reason underlying the booming popularity of mail-order pharmacies. “Brand-name drug prices have increased at triple the rate of inflation” in recent years, McHugh noted. But mail-order pharmacies--because they deal in large volume, have relatively low overhead costs and encourage the use of lower-priced generic drugs--can often offer consumers dramatic savings over the corner drugstore.
Exact savings vary, but can be great even with the postage and handling fees some services charge. The ElderMED Mail Order Pharmacy Service and CliniShare Direct Rx claim savings of “up to 50%.” A 100-tablet bottle of 400 mg Motrin (ibuprofen), an anti-inflammatory drug commonly prescribed for relief of arthritis pain, costs $12.69 for the brand name and $9.75 for the generic equivalent through the ElderMED service. At a major chain drug store in La Crescenta, on the other hand, the same medication costs $20.35 for the name brand and $10.45 for the generic equivalent.
The prescription mail-order process is similar to other mail-order businesses. For instance, customers who use ElderMED Mail Order Pharmacy Service choose needed drugs from a price list and then fill out an order form, noting the name and quantity of the drug and its price. They choose whether they want the generic equivalent and child-proof tops and insert a copy of the doctor’s prescription if it is a new one. (For refills of drugs previously ordered through the service, customers simply note the prescription number. For non-prescription drugs, customers note the quantity and name of the item along with the price.) Less frequently, according to Chang, a doctor phones in a prescription directly to the pharmacy.
ElderMED customers can pay via check or charge card or they can choose to be billed. “Our experience to date is payment is being received in a timely manner,” said Marty Keller, vice president of professional services for CliniShare.
Although most services ship within one or two days, delivery can take anywhere from a day to seven days or more, depending partially on the speed of the post office or other delivery services.
Special Delivery
Tampering has not been a problem, according to Chang. Since postal regulations forbid the mailing of narcotic drugs, mail-order pharmacy operators said they ship those drugs--and any others with abuse potential--via delivery services that require a signature. Some mail-order pharmacies don’t ship certain drugs with abuse potential.
Many of the mail-order pharmacies offer extra services such as toll-free numbers for advice or ordering information. The Chatsworth services, for example, list an 800 number and invite subscribers to call the pharmacist with questions about possible drug interactions and side-effects.
The AARP Pharmacy Service, with corporate offices in Alexandria, Va., prints drug leaflets to tell people about medications, said Nancy Olins, director of program development for the service, which fills 7 million mail-order prescriptions a year.
McHugh predicts continued growth for mail-order pharmacies. Employers, in particular, look on the services, he said, as an effective way to contain health-benefit costs.
Mail-order pharmacy operators new to the business say they’re encouraged by the number of repeat customers. Wilson of Inglewood is one of those customers. He plans to reorder through the ElderMED Mail Order Pharmacy Service, he said, for two simple reasons: “The prices are very reasonable, and I find the service very good.”
