Regarding Mail Order Pharmacy

[shaq786]

Few questions:

1. Is online pharmacy the same as mail order pharmacy?

2. Why do patients get so many great deals on their copays by doing lets say a 90 day mail order vs. 90 days from a local retail pharmacy?

3. Why do customers even bother coming to a retail or hospital pharmacy when their getting such a great deal from mail order? All they have to do is make sure they refill their prescriptions in a timely manner, and I'm sure those mail order pharmacies do the best to get the drugs to their patients in a timely manner.

4. Why dont websites like these http://www.order-cheap-cialis.com/order.html, ask for your prescription when selling you these drugs? I always thought any drug that is being shipped to the U.S. has to have a corresponding prescription in the hands of the organization shipping you the drug.

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[WVUPharm2007]

Is online pharmacy the same as mail order pharmacy?

Insofar as how the job is done, there probably isn't much of a difference.

Why do patients get so many great deals on their copays by doing lets say a 90 day mail order vs. 90 days from a local retail pharmacy

The mail order companies are either owned or contracted by the insurance companies. Filling the drug themselves rather than feeding profits to the community pharmacy is one of the newer cost-saving strategies the insurance companies are instituting. But - is it leading to increases in mortality and morbidity.....? I would wager - yes. I actually hope some serious studies that would go into costs racking up when a pharmacist isn't seen in person.

 

[shaq786]

But - is it leading to increases in mortality and morbidity.....? I would wager - yes. I actually hope some serious studies that would go into costs racking up when a pharmacist isn't seen in person.

Can you further elaborate? Thanks.

 

[eddie269]

Education on their medication, how to use it properly, possible side effects, proper dosage being given out, any other health related concerns, etc.

 

[sdn1977]

These are actually very good questions!

Mail order & online pharmacies are very similar. But, mail order normally contracts with a PBM or an insurer, therefore, is not open to the public.

For example, XYZ mail order pharmacy may fill rxs for all of Caremarks, United Health Care & BCBS CA mail order contracts, but not Cigna or Aetna. Kaiser itself has its own mail order as does Walgreens.

Online pharmacies are available to the public. DrugStore.com & Walgreens both have public availability (altho they may privately contract as well).

The key here is - they must be licensed in ALL the states they mail to. The pharmacists working there must just be licensed in the specific location they are in, but the corporated entity must be licensed in all states. Some have not done this & have paid a huge financial price. Your examples are of some illegal online pharmacies. You can check if your online pharmay is legal by going to NABP/pals.com. The PALS Program was designed in 2006 to authenticate online licenses. This will become more important as drug pedigree becomes an issue in 2008. Likewise, the DOJ & FDA both monitor those online rx sites....so, don't get caught there as a licensed person - you can get burned!

Ownership of these pharmacies is becoming troublesome as well as marketing practices which prevent the pt from utilizing a regular retail operation. In fact, there is a current recommendation in CA to not allow an insurance company to provide the incentive (or disincentive) for mail order in the future. The copays must be the same & the ownership & origination of the rx (what state it comes from) must be available to the pt. If it were me, I wouldn't want my Enbrel shipped from Nevada or south Texas to Washington in the summer - but, thats my personal preference.

Why do pts do it - price & convenience. There are some very, very rural areas in which it makes sense. However, in urban areas, stolen rxs run very high (like that of stolen SSI checks & ID theft). But, we have studies which show that co-pays will affect drug usage (JAMA 2004:291:2344-2350). However, we are seeing more recent anecetdotal studies which indicate that regular visits to someone who monthly will reinforce usage & monitor side effects decreases morbidity, but does increase drug usage (in other words - pts use their medications rather than "skip" their medications due to a variety of reasons....delays, forgetfulness, etc..)

The problem here is the disconnect between isurers - the pharmacy benefit - who pays for the rx - is different from the medical insurer in many cases. The pharmacy benefit manager doesn't really care if the pt continues to take their lasix or not. If the pt's renal function goes low enough, lasix becomes of little use (pharmacy $$), but the pt needs dialysis (medical $$). The right hand doesn't know nor care what the left hand does. - This is the fragmentation of healthcare currently.

 

[WVUPharm2007]

Why do pts do it - price & convenience. There are some very, very rural areas in which it makes sense.

I disagree. In WV - the most rural state in the East - there are plenty of pharmacies in even the more isolated counties. Alaska may be an exception.

 

[sdn1977]

I disagree. In WV - the most rural state in the East - there are plenty of pharmacies in even the more isolated counties. Alaska may be an exception.

I was thinking more Wyoming or Montana where you have to drive 45 minutes to get to town just to find they have to order the medication then drive back again.......

WVU is becoming its own metropolis!!!! In fact, a megalopolis of pharmacies !

 

[pharmacyanalyst]

http://www.nu-retail.com/mail_order_pharmacy_market.pdf

This is a great paper about the mail order industry. I work for a insurance company who runs their own mail order pharmacy. I actually manage the contracts with the pharmaceutical companies. Like the article says- most of the savings comes from the ability to contact the physician regarding formulary changes.

 

[TBS5280]

I work retail and the main complaint about mail order is the inconvenience. Also, you do not get that personal touch that a pharmacist provides. We have many customers who refuse to do mail order even though they would save a copay when doing a three month prescription. In addition to, many patients are on thryoid medications who have to get routine blood tests and so are changed from time to time on strength of med.

 

[penguins429]

I'm currently working as a tech at a specialty "mail order" pharmacy ... (although we're not actually considered mail order by most insurance companies, we do ship all of our prescriptions to our patients, so I consider us to be mail order) ...

... anyway, it seems like our patient's either love the whole mail order idea, or hate it ... some love the fact that their medications are delivered to their home every month (or every 3 months) with little to no complications or effort on their part ... others hate dealing with everything over the phone, shipping and delivery problems, etc ...

... from my perspective, it sucks ... it is definitely not the environment I want to work in when I graduate ... sometimes i actually forget I'm working in a pharmacy because I just sit in my cubicle all day dealing with shipping and insurance problems all day, with very little patient interaction ... and the only real interaction I have with the patients is over the phone, which make them seem more like random voices than actual people ...

... from a business standpoint, mail order pharmacies are great ... we are very efficient ... as compared to regular many retail pharmacies, where every tech pretty much helps out in all areas; our techs are specialized in a certain area -- we have filling techs (just count the pills all day), shipping techs, new patient enrollment techs, refill techs, etc ... which allows us to have a very high daily output ...

*a little off topic from the original post- but just a little insight about my mail-order experience*