Pros and Cons of Mail-Order Pharmacy Services: Views From Clinicians, Patients

In 1946, the United States Veterans Administration became the first organization in the United States to provide medications for its patients by employing a mail delivery service through individual VA medical facilities for eligible veterans.^1,2 Additionally, in1959, retiree members of the National Retired Teachers Association (later referred to as American Association of Retired Persons [AARP]) were offered mail-order pharmacy services as part of their membership.¹

Sources also indicate that mail-order pharmacy services did not begin to expand in popularity until the 1980s and primarily still served the older patient population.¹ As time went on, throughout the 1990s, the number of mail-order pharmacies continued to increase as the number of individuals interested in more convenient and cost-effective means of obtaining their prescriptions grew. By the 2000s, more employers began to provide mail-order pharmacy as an option to employees.¹ The COVID-19 pandemic also increased the use of mail-order pharmacies due to its convenience—many retail pharmacies offered home delivery of prescriptions and still do.

Some publications have indicated that mail order pharmacies are associated with enhanced patient compliance and lower health care costs.³ Moreover, literature notes the use of mail-order pharmacies offers patients several benefits, including the convenience of home delivery, ability to use online ordering, automatic refills, tracking services for delivery, and provision of a 90-day supply.³

In discussions with clinicians and patients about the pros and cons of mail-order pharmacy services, there were mixed views. However, the majority seem to like the conveniences offered by mail-order pharmacy services. Below are a few insights from clinicians and patients:

Clinicians' Opinions

“Mail-order pharmacies have a big role in health care because they are great for patients who can’t make it to the pharmacy. These services were wonderful during the pandemic for patients who wanted to take precautions. The con associated with mail-order pharmacy services is that many older patients tend to take multiple medications and tend to have trouble keeping refills coordinated.”—a family medicine internist

“Mail-order pharmacy services provide convenience of delivery and automatic refills of maintenance medications and may provide patients with lower costs; however, the downside is patients often have a surplus of medications if prescriptions or dosages are changed. I think it depends on the patient’s preferences. I find that patients who take an active role in their health care tend to be more compliant to therapy, and mail-order pharmacies make it easy for patients to get their medications.”—an emergency room doctor

Patients' Opinions

“I use a mix of retail pharmacies and mail-order pharmacies depending on the prescription. Mail order is great for my maintenance medications, and I find the services to be efficient and cost-effective. I do like to get one time or short-term prescriptions through the retail pharmacy because it is quicker.”—an older patient with multiple medical conditions

"I do not like mail-order pharmacy because when my doctor changes a prescription, I have been left with a surplus of medication. I prefer getting medications on a month-to-month basis and talking to the local pharmacists.”—an older patient with multiple comorbidities

“I love the convenience of mail-order pharmacy, but I worry about delivery delays, and nothing beats face-to-face communication with the pharmacist.”—a patient with hypertension

“While mail-order pharmacies are convenient and associated with lower costs, I often end up with more medication than I need. I have always been concerned about the safety of my medication when it is exposed to extreme temperatures during delivery and after sitting in my mailbox. Also, once my doctor sent a prescription that I needed immediately to a mail-order pharmacy, and the medication delivery was delayed.”—a patient with osteoarthritis

Conclusion

There are many advantages associated with mail-order pharmacy services such as convenience, lower costs, and often a 90-day supply of maintenance medications. Documented disadvantages include delays in the receipt of medications needed immediately, potential for delivery delays (especially in inclement weather), and issues with medications that require refrigeration or special packaging.

Pharmacists and prescribers can be instrumental in providing patients with information about reputable mail-order pharmacies and encourage patients to contact their insurance companies for more information. As a result, patients and caregivers can make informed decisions about whether mail-order pharmacy services meet their needs.

Overall, the most important goal is to ensure that patients have access to the prescription medications they need and adhere to recommended treatments to improve overall clinical outcomes and health-related quality of life.

A special thank you to all who provided their opinions about mail-order pharmacy services.

References

1. Nelson JB. The role of mail order prescription services. RxBenefits. June 4, 2021. Accessed August 24, 2022. https://www.rxbenefits.com/blogs/role-of-mail-order-prescription-services
2. Veterans Health Administration. Audit of Consolidated Mail Outpatient Pharmacy Program. 15-05255-422. Department of Veterans Affairs, Office of Inspector General; 2016. Accessed August 24, 2022. https://www.va.gov/oig/pubs/VAOIG-15-05255-422.pdf
3. Do D, Geldsetzer P. Trends in mail-order pharmacy use in the US from 1996 to 2018: An analysis of the Medical Expenditure Panel Survey. Am J Prev Med. 2021;61(2):e63-e72. doi:10.1016/j.amepre.2021.02.017