Mail order drugs flying off shelves

Elaine Naleski gets her medicine by mail. The Lipitor she takes to control cholesterol costs $75 for a three-month supply; a blood pressure medication costs $20.

The prescriptions come to her in a plain, heavy-duty envelope from a pharmacy in New Jersey — part of her benefits package through Colorado Springs School District 11, where she’s the director of communications.

After a lifetime of dealing with local pharmacists face to face, Naleski wasn’t too happy when the district switched to the mail order benefit for her long-term prescriptions, but she’s changed her mind.

“I’m doing it online, they send me a reminder, they have my credit card on file,” she said. “I just click ‘I need to refill.’ I don’t have to drive to a pharmacy. I’ve just found it to be a lot more convenient.”

Mail order prescriptions have been around for decades, but they’re now big business as many health insurance plans require them for “maintenance drugs,” those taken regularly for chronic conditions.

The trend is biting into the business of local pharmacists, who say in some cases the personal touch they offer is not only more pleasant, but safer.

In recent years, large employers including Microsoft, General Motors Corp., Boeing and Ford Motor Co. have made mail order drugs mandatory for employees with long-term prescriptions. Under such a program, medications for immediate needs, such as antibiotics, still are filled at a local pharmacy.

Cost savings is the reason for the industry shift — mail order companies can cut costs by buying drugs in bulk and eliminating overhead by using automated filling systems.

The Pharmaceutical Care Management Association estimates mail service will save at least $85 billion in drug costs by 2016. The trade organization represents pharmacy benefit managers, companies that typically run mail order services and negotiate drug benefits for health plans and employers.

NextRX, the pharmacy benefit manager that services Anthem Blue Cross Blue Shield, has grown 20 percent a year for the past five years, said Tim Hopkins, vice president of retail, mail and customer service operations. About 17 percent of prescriptions for Anthem members are filled through mail, Hopkins said, about 11 million prescriptions this year.

That’s in line with the national average, according to Drug Benefit News, a biweekly industry publication. Estimates are that 19 percent of prescriptions are filled through mail order. The number is predicted to jump to 25 percent by 2011.

The convenience of mail order service appeals to patients, Hopkins said.

“Our average turnaround is 1.5 days,” he said, “and you don’t have to drive to the pharmacy. Our automated system fills prescriptions accurately and quickly.”

Prescriptions from doctors can be mailed, called or faxed in, or, if the patient wants, the service will contact physicians for the order, he added.

And a pharmacist is available via phone 24 hours a day to discuss medications or diseases, Hopkins said.

Some insurance plans offer savings on co-payments for using mail order, and discounts on prescriptions can vary from 10 to 25 percent over retail, depending on whether generic drugs are substituted for brand names, according to a Pricewaterhouse-Coopers study.

Not everyone thinks the system is the best antidote to spiraling health care costs.

Rich Doyle, president of the Colorado Board of Pharmacy and owner of an independent pharmacy in Sterling, said the practice hurts local pharmacists and isn’t always good for patients.

“I’m very biased,” he said. “It takes business away from the local community. I’m sure I’ve lost business. I know any number of people who get part of their medications from mail order.”

Doyle, who also sits on the board of the Colorado Pharmacists Society, said patients miss out on personal interaction with a pharmacist — the kind that used to exist at the old-fashioned drug store.

“Who are they going to ask for counseling? The mailman who delivers it?” he said.

Doyle said that face-to-face discussion can be crucial in averting potentially dangerous drug interactions and dosing problems.

He cited two recent instances in which patients at his pharmacy benefited from coming to see him.

In one case, which he said happened less than two weeks ago, a doctor wrote a prescription for Zantac syrup for a small child. “The physician made an assumption about the strength of it,” Doyle said of the medication, often used for ulcers and reflux disease. The doctor had dosed it wrong, which could have resulted in an overdose for a tiny patient. Doyle called the doctor and got it resolved.

“That’s minor, but that’s the kind of thing I’m talking about. They (the parents) were grateful that we caught it,” Doyle said.

He said he’s had to work harder to keep customers and attract new ones. That means investing in the best technology and improving service. Not only does his pharmacy provide home delivery, Doyle also schedules open houses, flushot clinics and customer appreciation days.

He said the personal touch has allowed him to compete against the Walgreens and mail order houses. His business, Walker Pharmacy, has been around since 1960 and fills an average of 300 prescriptions a day.

The “coming trend” of mail order prescriptions isn’t always a cost-saver, said Brian Wilson, a pharmacist at Ivywild, a locally owned pharmacy.

One problem with mail order is waste from patients having to order three months at a time, when a prescription might change in the interim, he said.

“I fail to see that much cost savings with the service,” Wilson said.

Elderly customers may have the hardest time with mail order prescriptions, said Barry Patterson, a pharmacist and owner of two Medicine Shoppes in Colorado Springs.

“It’s difficult for them to remember to order their drugs, or they have a problem with the voice-activated systems — and then they call me, and I don’t have it in my heart not to help them,” Patterson said.

“I don’t think it’s right to make it mandatory — people should have a choice.”