Finding It Tough to Compete With Mail-Order Drugs
Consumers’ growing infatuation with ordering prescription drugs by mail could pose a threat to pharmacies’ efforts to attract more customers by expanding into more medical-related services.
The amount of money spent on prescriptions through mail order grew from 4.9% of total spending in 1989 to about 14.5% last year, according to IMS Health Inc., a pharmaceutical research firm. And the California Pharmacists Assn. says the number is expected to keep growing, especially as more health plans encourage members to refill prescriptions by mail.
Pharmacists contend that the practice not only cuts into their profits but may pose health risks to patients.
“The people being pushed into mail order tend to be the people taking the most medication--the elderly, the very sick,” says Michael Pavlovich, president of the California Pharmacists Assn. “Any time you are taking more than one prescription, there is a chance for an interaction.”
Mail-order prescriptions filled through a single health plan would still be monitored to avoid potentially dangerous drug interactions, says Glenda Owens, a spokeswoman for Prescription Solutions, PacifiCare’s pharmacy benefit plan.
Health plans that encourage members to order prescriptions by mail say it reduces costs for both the plan and the consumer. And members often can get a 90-day supply of medicine by mail order, compared to a 30-day supply if purchased in a pharmacy.
“If a consumer is taking five medications, they could save as much as $50 [in insurance co-payments] every three months” by ordering by mail, says Owens. “And mail order is a big convenience. We have a lot of seniors who use this system.”
About 10% of all prescriptions for PacifiCare members are ordered by mail, and the health plan expects that activity to grow by 25% a year, says Owens.
“We haven’t recruited members to use mail order, but we will start to do so,” says Owens.
She says members are encouraged to use mail order only for refills, although they are allowed to submit new medications for mail delivery. However, it takes five to seven days to receive medication.
Most consumers, Owens says, still maintain a relationship with a neighborhood pharmacy for filling such things as antibiotics.
“We’re not writing off the retail pharmacist,” she says.
But, according to Pavlovich and the California Pharmacists Assn., offering more medication per co-pay through mail order only is “an unfair business practice.”
The CPA helped launch legislation this year, called the California Prescription Drug Equity Act, designed to force health plans offering drugs through both community pharmacies and mail order to extend identical co-payments and supply amounts no matter how the prescription is filled.
The bill, SB 1922, was introduced by state Sen. Jackie Speier (D-Hillsborough) but was not successful.
Consumers, meanwhile, may have to weigh price and convenience against service, suggests Pavlovich.
“Consumers may feel they are spending less [through mail order], but we think they are getting less too.”
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What the Law Says
Several laws were passed in the 1990s to expand the pharmacist’s role as a patient-care provider.
* Consultation: A federal law that went into effect in January 1993 requires pharmacists to maintain patient profiles and records, and to offer counseling to patients with new prescriptions.
* Reimbursement for consultation: A California law that went into effect in 1995 enables pharmacists to receive payments for services not related to dispensing prescriptions.
* Skin puncture: A ruling last year from the California Senate Committee on Business and Professions clarified pharmacists’ authority to perform skin punctures used for blood tests.
* Collaboration with physician: A California law that went into effect in January allows pharmacists to initiate and monitor drug therapy for patients in collaboration with their doctors.
