Slow or ineffective service by mail-order pharmacies is forcing many US patients to go without prescribed medicines, claims a new survey.

63% of patients who are required by their health plan to use mail order reported that they had experienced late delivery, compared to 28% of those who had a choice of pharmacy, and 48% of respondents who were mail-order customers said they had had to go without medications because of late delivery, according to the survey, which was conducted by the National Community Pharmacists Association (NCPA).

Patients reported that they routinely have to pay for prescription drugs twice – once for the mail order and a second time at community pharmacies for an emergency refill when the mail-order purchase did not arrive in time, and they were also unhappy about having to purchase a 90-day supply through mail order only for their physician to write a new or different prescription two weeks later, leaving them with two months’ worth of unusable medicine, says the Association.

Mail-order pharmacies are owned by the pharmacy benefit managers (PBMs) employed by health plans to administer prescription drug benefits and negotiate prices. According to the NCPA, it is “common” for PBMs to charge a plan sponsor a much higher amount than it would a community pharmacy for dispensing the same prescription, subsequently “pocketing the difference,” and passing those higher costs on to health plan sponsors and, ultimately, to patients, without disclosing them.

The NCPA survey was published the day after research firm JD Power’s annual comparison of customers’ views of “brick-and-mortar” and mail-order pharmacies found high levels of satisfaction with the latter.

Commenting on the contradictory findings, the Pharmaceutical Care Management Association (PCMA), which represents PBMs, said that “both can’t be right,” but added: “in weighing the facts, policymakers may…want to consider other independent, peer-reviewed data showing that mail-service pharmacies dispense prescriptions with more than 20 times the accuracy of traditional brick-and-mortar pharmacies. Furthermore, government studies show that mail-service pharmacies typically dispense prescriptions at lower prices than traditional pharmacies.”

“Savings from broader use of mail-service pharmacies could be used to offset the Average Manufacturer Price (AMP) payment increases being so aggressively pursued by NCPA and others,” added the PCMA. This is a reference to the federal court approval earlier this month of a settlement involving drug pricing publishers and wholesalers which had been accused by health plans of manipulating Average Wholesale Prices (AWP). The court also approved a subsequent rollback of prescription drug prices, which is due to take effect on September 26 and is opposed by the NCPA, the National Association of Chain Drug Stores (NACDS) and the National Alliance of State Pharmacy Associations (NASPA), which claim that it could cost their members more than $550 million a year.