By guest blogger Michael Cohen:
An article in Sunday’s Inquirer by business columnist Jeff Gelles explained how health insurers and their contracted pharmacy benefits managers (PBMs) make it financially attractive for you to get your prescriptions filled by mail-order pharmacy (usually owned by the insurer or PBM) rather than your local community pharmacy. For example, you may be able to get a 90-day prescription for one co-payment vs. only a 30 day supply at a local pharmacy.
That’s not the whole story though, and if you haven’t read the article you should. It’s a good examination of a number of controversies you should be aware of from the standpoint of what might be best for you – the health care consumer. I’m not sure if you’d consider it more worthwhile to get your medications mailed to your home or at your local pharmacy, but here are some other things I think you should keep in mind.
Emergencies. Understandably, mail order cannot address emergencies and prescriptions and medications prescribed for acute illnesses. Community pharmacies also serve patients that need help when their medications run out before mail order deliveries arrive. The medications may be in transit, “lost” in the mail, or never sent if, for example, a faxed prescription was never processed. Regardless of the cause of the delay, patients have often relied on community pharmacists to help them obtain an interim supply of medications. As the article above pointed out, they’ll do it, but it’s a great frustration since they don’t get paid for the time it takes them to make all the necessary phone calls for approval from the PBM.
Face-to-face counseling. As mentioned above, dispensing errors have often been averted when counseling patients about the medication, reason for use, dose, route, and directions for taking the drug. This offers patients an opportunity to speak up if any information does not match their expectation. Unfortunately, mail order pharmacies, at best, can provide counseling over the phone if the patient calls with questions. Some patients have opted instead to ask a pharmacist in their community for advice.
Dispensing accuracy. There isn’t much evidence that one type of dispensing system offers greater safety over the other. Many errors happen when a prescription is misread due to handwriting issues. That happens in both systems. But these days, pharmacies of all types are receiving a computer-printed prescription or an electronic transfer from the doctor’s office, so this is becoming less and less of an issue. And virtually all pharmacies are computerized and check for drug duplications and interactions. Bar code scanning to match prescription with the drug container is now the rule in over 50% of the nation’s community pharmacies according to a yet-to-be published ISMP study. Robotics, adopted early in mail order pharmacies, has also been adopted by very busy community pharmacies. While noisiness and error-prone interruption is less of a problem in mail order operations, there’s also something to be said about internal check systems and face-to-face communication in community pharmacies, which allows immediate recognition of dispensing errors, as long as the patient demands a quick meeting with the pharmacist before leaving the pharmacy.
Community and mail order pharmacies share a common goal of ensuring that patients have access to the most appropriate, effective, cost-efficient, and safe pharmaceutical products. Together, they should explore more seamless medication dispensing services to reduce fragmented care, improve handoffs when necessary, and promote continuity of pharmaceutical care. Truth be told, whether by choice or need, mail order pharmacies need to work in tandem with community pharmacies to provide the best service possible to patients. Community pharmacies excel at offering a personalized means of providing medications and clinical services via a widespread network of providers–a network that mail service pharmacies also need to be successful.
For information on the Institute for Safe Medication Practices' consumer website go www.consumermedsafety.org
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