As the medication experts on the healthcare team, pharmacists understand the negative impact when patients do not have access to their necessary and life-saving medications. For many unfortunate reasons, the current disruption with the United States Postal Service (USPS) must be addressed as millions of patients receive their medication by mail and thus are facing unnecessary and unplanned interruptions to their healthcare. Although subsequent disruptions have been delayed until November, the impact of the changes already made, and those made after the election could result in patient harm. While pharmacy organizations have recognized disruptions in medication access must be addressed immediately, they have decided to use this opportunity to focus on a different issue – PBM reform.
USPS and The Impact of Disruptions on the Medication Delivery System
With more than 90% of Americans living within five miles of a pharmacy, the pharmacy is an essential community health center for many patients. While many patients do use their local pharmacy to fill prescriptions or obtain over-the-counter products, there are millions of patients who utilize mail order services for their routine medications. For example, the US Department of Veterans Affairs fills 80% of veterans’ prescriptions through the mail. This equates to around 120 million prescriptions per year for the veteran population, though this estimate is thought to be inflated. In the United States, for every 100 people, 50 prescriptions are sent through the mail. Although some of these medications may be delivered via FedEx or UPS, the utilization of the USPS to distribute medications is a vital piece of the healthcare delivery infrastructure in the US. The recent analysis from Drug Channels Institute may lead one to believe that a majority of patients that receive medications from the mail will not be affected by the USPS disruptions, however, as the American Pharmacists Association (APhA) stated in their press release on this issue, “Any patient that goes without one prescription is too many.”
When patients who typically use mail order for their prescriptions face shortages of their medications, they also turn to their local community pharmacy. Because of changes with the USPS, pharmacists are increasingly working with patients going without access to their medications, or who are facing an unnecessary burden to receive their medication. The disruption of the medication delivery infrastructure may result in increased strain at other points in the supply chain. This strain could result in decreased access to medications, decreased efficiency of medication dispensing, and increased burden on pharmacists and pharmacy support staff.
Patient’s Right to Choose
Use of mail order services have been shown to improve medication adherence, including for stroke survivors and patients with diabetes. Utilizing such services can remove barriers such as transportation to and from pharmacies and allow patients to maintain access to medications during pandemics. However, we do support that patients should be able to choose whether or not they want to take advantage of mail order pharmacy services.
Increasingly, patients are required to use mail order pharmacies, or another location that is not their local and preferred pharmacy. Although we do agree that elected leaders need to review current policies which may restrict patient choice and provide legislative and regulatory recommendations to limit these activities, taking this opportunity to focus on PBM reform seems like an easy way to circumvent the real issue and avoid taking a stance on an issue that is clearly affecting our patients. Let’s not lose track of what really matters – the patients. Even without PBMs requiring patients to utilize mail order services, some patients would (and perhaps should) continue to want to utilize mail order services.
There is no doubt that when patients lose access to their medications, either through temporary actions or through requirements that do not allow them to use the pharmacy of their choice, patient health and safety is put at risk. While Americans continue to struggle with healthcare costs and issues with access to care, pharmacists must be focused on maintaining patient access to medications in order to: 1.) Improve patient health outcomes, 2.) Maintain patient safety, and 3.) Reduce overall healthcare cost through effective use of medications.
In other words, we should remain focused on the overall well-being of our patients. Immediate cessation of legislative or regulatory action that disrupts the medication supply chain infrastructure, thus jeopardizing patient access to healthcare, is needed. Through appropriately funding USPS services, patient access to medications through legitimate mail order services can be delivered in a timely and effective manner. As this news story falls out of the headlines, we must remain vigilant to observe consequences of disruptions and further disruptions following November. Many of our patients may not have the ability to advocate for themselves when access to their healthcare is infringed upon, but as a profession, we can be the voice that brings forth concerns when our patients are put at risk.