I would like to begin this article with a story that is sweeping through our country with mega PBM’s mandating the course of healthcare for us and our patients that we care for, by forcing subscribers to use mandatory mail order pharmacies.


The patients being forced to use mail order are the MOST vulnerable, those with chronic diseases such as HIV/AIDS, who need their local trusted pharmacist the most.

Two of my HIV patients (life partners) whose therapy I have managed for over ten years, bringing both of them back from the brink of a catastrophic outcome from AIDS to healthy individuals who have great jobs and successful careers. I have been a pivotal member of their healthcare team throughout their journey.


About one year ago their Insurance Company mandated that they MUST use the mail order pharmacy for their chronic medications, namely their antiretrovirals, and could still obtain other meds from the local pharmacy (This could be a fatal consequence in HIV Care where major drug-drug interactions are common and adherence is pivotal to successful outcomes).


Three months ago the patients contacted me and were “frantic” as they explained their experiences with the mail order pharmacy. By this time they had been using the mail order pharmacy for a year. Not a month went by where they both received their prescriptions on time in the mail. They never received any consultations on their medications either. WHERE THEY EXASPERATED?! Fortunately, they were both on the same anitiretroviral regimen and could “share” the medication until the other medication arrived. The mail order pharmacy never offered a solution for the problem. They were toying with the life of my patients!


I contacted the insurance company and asked for an exemption to the mandatory mail order clause and it worked. They are now able to get ALL their medications from “their local pharmacy”, where they trust the staff and know they have the pharmacists on their team to make sure their drug therapies are managed appropriately.


Patients need to be given a choice to use their local pharmacy or mail order pharmacy.  It’s sad and wrong they are penalized for choosing their local pharmacy.


When our patients walk away from the pharmacy counter, without a proper consultation, carrying the bag with their medications, it’s as if they are walking away with a loaded gun. How they take that medication, what to expect, how it interacts with other medications, addressing their questions and concerns- This is what makes us professionals and why we spend thousands of dollars and years of out lives becoming the experts in our field. Direct interaction and consultation with our patients is how we directly impact the healthcare system by decreasing costs of drug related morbidity and mortality and improving the outcomes and lives of our patients. The costs of drug related morbidity and mortality is now estimated at $177.4 billion[1].


We have all heard the horror stories from our patients BUT they have also been confirmed in patient satisfaction surveys where it was clear that in areas of “efficient functioning of the pharmacy” and “role of the pharmacist in managing therapy” Independent Pharmacies outscored mail order pharmacies all around[2].


When treating chronic diseases it is the community pharmacist that makes the difference, ensuring appropriate medication use and making a positive impact on the health of patients, decreasing overall healthcare costs, and not the mail order machine, with prescriptions filled by robots, late mail, unnecessary prescriptions filled and no relationships and interventions by staff [3].

[1] The Cost of Drug-Related Problems Revisited- Linda Bernstein PharmD http://www.medscape.com/viewarticle/431686

[2] Evaluating the validity and reliability of a modified survey to assess patient satisfaction with mail-order and community pharmacy settings. Pinto SL, Sahloff EG, Ramasamy A, J Pharm Pract. 2010 Apr;23(2):128-34. Epub 2009 Apr 10

[3] Antiretroviral therapy adherence, medication use, and health care costs during 3 years of a community pharmacy medication therapy management program for Medi-Cal beneficiaries with HIV/AIDS. Hirsch JD, Gonzales M, Rosenquist A, Miller TA, Gilmer TP, Best BM J Manag Care Pharm. 2011 Apr;17(3):213-23.