Pills by post: The pros and cons of mail-order pharmacies

CVS does it. Walgreens does it. Now Amazon is getting in on the act. They're all dispensing drugs by mail.

With nearly 3 in 5 American adults taking at least one prescription drug, odds are your health insurer has steered you toward a mail-order pharmacy. And, if they haven't, they probably will soon.

"It's all about convenience. You don't have to leave home or wait in long lines. Plus, it's easy to get all your medication refilled and shipped at one time and is usually more affordable," says Mohamed Jalloh, a pharmacist and the official spokesman for the American Pharmacists Association.

Don't confuse mail-order pharmacies with sketchy discount internet storefronts or foreign-based suppliers. Instead, these are pharmacy benefits-management companies that health insurers contract with to lower costs by negotiating discounts and rebates directly with drug manufacturers and wholesalers, as well as administering your drug-payment claims.

The concept isn't new. In many ways, Veterans Affairs is considered a pioneer of the contemporary mail-order pharmacy business. As early as the mid-1970s, VA, formerly known as the Veterans Administration, operated regional pharmacies where prescriptions were filled and mailed to patients. The first "highly automated" VA national mail-order pharmacy was established in 1992 on the campus of the Leavenworth VA Medical Center in Leavenworth, Kan. Now, more than 330,000 veterans receive prescriptions in the mail every work day.

Don't worry: There aren't any R2-D2s filling prescriptions without human supervision. Although automation has taken over many tasks, thousands of pharmacists and pharmacy technicians work at mail-order outlets.

"Whether it's a retail store or mail order, a licensed pharmacist physically checks every prescription before it goes to the recipient. It's the law," says Albert Wertheimer, professor of social and administrative pharmacy at Touro College in New York City.

Kirk Nilson, senior vice president of home delivery operations for OptumRx, a pharmacy-care services company that manages more than 1.3 billion prescriptions annually, describes how the system ensures accuracy. Medications are sorted and scanned using high-resolution and high-speed scanners. All information is verified by pharmacists and undergoes up to 16 fulfillment quality checks. For instance, he says, if a prescription calls for 90 pills of a specific drug, the system knows what the total weight should be. A mismatch diverts the prescription to an employee for a recount and visual inspection to ensure the drug matches a picture of the medication's shape, markings and color.

Kaiser Permanente's six mail-order facilities are licensed like any other brick-and-mortar pharmacy, says Amy Gutierrez, senior vice president and chief pharmacy officer. "The only difference is we have a much larger staff and a higher volume."

Thinking about signing up for prescriptions by mail? First, understand your drug benefits. Contact your health insurance provider and have them explain not only your plan's coverage, but any price difference between filling your prescriptions at a local pharmacy or by mail order. Then, consider these other factors.

Mail order may be for you if:

• You like saving money and gas. In addition to often passing on savings to customers in prescription costs, mail-order pharmacies offer free shipping.

• You dislike wasting time. No more driving to a pharmacy and standing in line waiting to pick up a refill. Even in crummy weather, your medications come to your door.

• You have a chronic illness. Those with gout, diabetes, arthritis or other diseases requiring long-term maintenance medications can order a 90-day supply. Not only does this mean fewer visits to the pharmacy, but most insurers give you a discount. "Instead of that usual co-pay for a 30-day supply at your local pharmacy, you can get three months for the price of one or two co-pays," Wertheimer says.

• You often forget to order or pick up refills. Mail-order pharmacies offer an automatic refill option, in which they charge your credit card on file and mail your medication before you run out. If you opt out of automatic refills, you'll still receive refill reminders by phone or email. They'll even contact your physician annually to renew your prescription.

• You want someone always on call. Have a question or concern? A team of pharmacists is available 24/7 every day of the year to talk to you on the phone.

It might not be for you if:

• You need a medication right now. If your physician prescribes an antibiotic or antiviral that you need to start immediately, it's best to head to your local pharmacy.

• You tend to set it and forget it. If you set up your account for automatic refills and you stop a medication or your physician changes the dose, you'll need to remember to stop automatic refills or they'll just keep coming.

• You take a compounded medication. Few mail-order pharmacies produce customized, made-to-order medicines. You probably will need to find a local pharmacy.

• You worry about loss. On rare occasions when a prescription goes missing, mail-order pharmacies will typically resend your medication at no cost. However, if you have real concerns about package theft, then it may be worth your time to pick up your prescriptions in person.

• You like the personal touch. "A pharmacist is a great resource. You can get a free consultation, no appointment necessary," Jalloh says. Many of us forget that pharmacists are medical professionals with at least six years of specialized study. Whether you need advice on the best over-the-counter medicine for a runny nose or which vaccinations are required for an overseas trip, a community pharmacist can help. And face it, a mail-order pharmacy can't give you a flu shot.

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