Friday, September 18, 2009

Pharmacists Can't Get No Satisfaction from Mail

Hot on the heels of Walmart’s mail pharmacy announcement, the National Association of Community Pharmacists (NCPA) issued a statement highlighting the purported dangers of using any type of mail pharmacy: Despite Wal-Mart's Assertion, New Mail Order Program Will Not Benefit Patients.

But at the risk of further annoying the irate independent pharmacists who post comments on this blog, I regret to inform you (and NCPA) that the facts do not show mail pharmacy to be an inconvenient, patient-killing scam.


NCPA, which represents owners of independent pharmacies, makes some pretty over-the-top claims about a dispensing channel (mail) that makes up more than one-fifth of the U.S. market.

Fans of hyperbole will LOVE LOVE LOVE this press release!!!

Here’s a small sample from NCPA’s press release:
"Deliveries can be delayed, sent to the wrong address, or damaged. Patients consistently complain to community pharmacists about having to do without their medication due to late mail order delivery. In addition, when bulk supplies are ordered, patients can wind up with an excessive amount of medications if any changes occur to what their doctor prescribes. All of those aforementioned scenarios occur under mail order—just ask patients who use the other large mail order companies like CVS Caremark, Express Scripts, and Medco Health Solutions.” (emphasis added)
Actually, somebody did ask patients.


The 2008 Boehringer Ingelheim Pharmacy Satisfaction Digest summarizes detailed survey responses from 34,454 consumers.

Page 46 presents the following results. Notice the first and third items on the list. (Click to enlarge.)

‘nuff said.


To my fellow readers who will be welcoming 5770: L'Shana Tovah!


  1. The community pharmacists really need to focus on the economics related to lower patient-pay and higher waste through mail-service. They would find that the savings to the client (e.g., employer) would be minimal at best. However, good contracting and benefit design could change this.

    I personally have used mail-service to save money on brand drugs and to avoid trips to the pharmacy. But I would be one of the people that answered "highly dissatisfied".

  2. Got this story in my inbox moments after your email:

    Some Health Plans Work to Promote Mail Order, But Others Simply Make Mail-Order Use Mandatory

  3. It’s important to note that in the exact same report, 69% of those surveyed were highly satisfied with their independent pharmacy, compared to only 47% with their mail/online pharmacy. Mail order pharmacists were also the least trusted, and patients were far less likely to have an opportunity to consult with their mail order pharmacist.

  4. A little off topic, but I think a major flaw in these satisfaction surveys is the fact that most people who use aweful pharmacies don't really realize how bad they have it. I actually just wrote about this topic the other day in The Disappearance of Customer Service in Pharmacies. In most pharmacies, customer service has gradually vanished over the years to the point that most people in the U.S. don't even understand what a real pharmacy experience should be like.

    If you look at these surveys, almost everyone is satisfied with their pharmacy. The fact that someone could wait 30 minutes for a single prescription to be filled, and then report that he or she is satisfied speaks volumes about the state of pharmacy in the U.S.

  5. There you go again bashing independents. Mail order does have drawbacks.
    1)many patients are just not displined enough to order in a timely manner.
    2)Fragmented pharmacy profiles can lead to risk to the patient, especially ones who dont know their meds.
    3)Delivery, where has your prescription set when its -40 degrees outside? On your porch or your mail box on the street? (not to mention the higher fees for faster than normal delivery)
    4)How many trips to the ER to get a prescription for enough to cover until the mail-order gets in will eat up the cost savings.

    Your campaign against independent pharmacies is quite amusing.

    I cant wait for your article about how the independents are pushing for pbm legislation.

    The Pbm's are robbing Americans blind. My 20% copayment for 90 simvastatin was 37.50, the pbm billed the health plan 187.50, the pharmacy only receive the copayment. The pbm pocked 150.00 on that single prescription. Your protecting your income, I'm trying to protect my family, my neighbors, and my fellow Americans.

    Why else would they be scared of transparency?

    The truth about Pbm practices will come out.

  6. To the folks above who accuse me of "pro-PBM bias":

    Let me remind you that my philosophy in writing this blog comes from the late Senator Patrick Moniyhan: "Everyone is entitled to his own opinion, but not his own facts."

    NCPA claimed (in a national press release) that consumers are not satisfied with mail order. A survey of 35,000 consumers by a neutral third-party shows otherwise.

    Nevertheless, I appreciate your comments. I don’t filter comments to so that the discussion can be as open as possible.


  7. Dr. Fein...

    Just what type of physician are you? I've viewed your profile and it tells me all I need to know...

    "...Foremost expert on channel economics and strategy. He helps his clients improve profitability and growth..."

    What is the proper shipping method for insulin? Enlighten us.

    L 'Shana Tovah? Seriously? You frighten me.

  8. To Enough Already:

    The type who doesn't have an anonymous profile (like you)?

    And yes, I was serious in my Shana Tovah wishes.


  9. I have to agree with most Americans having drugs mailed to your home is a bad idea. I work for Narconon drug rehab facility and i see a lot of young people who say that they got their medication from their friends or family so what is to stop them from stealing the medication before the person who the medicine is written for gets it.

  10. I've had a similar experience to Anonymous- if you have a coinsurance plan design and the PBM does not offer MAC at mail- you, and your employer, will be totally ripped off.

    Medco recently rolled out a $9.99 mail order program in response to the $4 retail will be interesting to see if it generates any significant utilization