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Questions About Medications by Mail

June 9, 2008

My drug coverage plan allows me to receive prescriptions by mail, and sends me an email about once a week to suggest that I do so. Some questions I need answers to but can’t readily find:

1) Can this be arranged so that refills just show up in my mail every 3 months, without my having to ask for it or do anything at all?

2) Will I have to sign for it? What if nobody is home, because we, uh, work?

3) If not, what if it’s stolen out of my mailbox?

4) What if the heat of the black metal mailbox affects the efficacy? They put those storage instructions on there for a reason.

4) If my drug coverage provider has been bought out by Giant National Pharmacy Chain, shouldn’t my loyalty be to my employer-run hospital pharmacy? At least it’s a kind of “local” business (loathe though I am to give my paycheck *back* to my workplace).

5) Why doesn’t the link to “find out more” in the email you sent me encouraging me to refill by mail actually lead me to answers to any of my questions?

Hmph. In other medication news, my post at OBOS today looks at researchers who failed to report acceptance of drug company money, and related legislation intended to disinfect the process with some good ol’ sunshine.

9 Comments leave one →
  1. June 9, 2008 4:43 pm

    Hi rachel,
    I use mail order pharmacy for the savings. I am on too many meds for a 30-something woman, but that’s neither here nor there I guess. Here is my answers based on the several mail order pharmacies I’ve used. Currently I use CareMark.

    1. No, this is a liability thing.
    2. No signatures needed for delivery.
    3. If it is stolen you can contact the pharmacy; they usually send emails saying it was sent and should arrive on such and such date so you know when to expect it. As far as worries about your private info getting into the hands of others, I see it as no different than any other protected info or even your bills. And besides, I’d imagine that if someone wanted to steal drugs in people’s mailboxes they are looking for narcotics and probably don’t care about anything else. BTW, in the almost 10 years of using mail order pharmacies, I’ve never had any meds stolen.
    4. Loyality is a tough thing, because in this country it means nothing.
    5. Good question. I have no idea.

  2. Eucritta permalink
    June 9, 2008 7:24 pm

    I used mail-in for some years through two different insurance companies, and only stopped recently. Based on my experience:

    1. No, I had to phone in and arrange for delivery each time. Both places had touch tone systems for sending in refills; the times these worked — about three times out of four — most of my meds were then shipped automatically and would arrive within three days. Meds which required refrigeration were shipped overnight on ice, and meds classed as restricted (such as narcotics) were also shipped overnight; with those, I got a live confirmation call-back, and they wouldn’t be shipped unless I could confirm I would be present to receive and sign for them.

    2. For most meds, no signatures were required. The exceptions were as above.

    3. I don’t work, so I was almost always around. Even those few times I wasn’t, we had an enclosed porch so I just left the outer door of that open and left a note asking that the parcel be left in there rather than in or under the mailbox.

    4. Meds which had to be refrigerated were shipped in styrofoam boxes with an insane number of icepacks — like, a dozen packs for a internal box about the size of a paperback book. Those which didn’t require refrigeration were shipped in oversized boxes wrapped in insulation and nestled in packing peanuts. Based on how the meds subsequently worked, I don’t think any were ever significantly degraded.

    5. Back when I had access to a locally-owned independent pharmacy, I stuck to them tooth and nail — not just out of loyalty to a local business, but because the two pharmacists there got to know their customers and paid attention to their prescription history. Thus, they functioned as another layer of oversight and information, and in my case twice caught prescriptions that would’ve interacted very, very badly with my other meds. So, if you’ve got a local pharmacy that knows you, I’d say, stick with ’em. Because the mail-ins, they don’t pay attention, and they also don’t provide any information other than the inserts the meds come with. One had nurses on-call to supposedly answer questions but when I called all they did was parrot the inserts, so. The mail-ins were also sometimes a royal pain in the ass to deal with — info got lost, the folks answering the phones weren’t well-trained and often didn’t know how to use the software, no-one ever seemed to know which department dealt with what … on an off week it was as bad and as maddening as calling the billing departments, and more than once their inefficiency resulted in significant delays in my meds. So, while I liked getting three months’ supply at once and the cut in copays, in the end, as soon as I was able, I switched. My current pharmacy is an impersonal chain and I don’t rely on them to check my scripts for incompatibilities, but they’ve been reliable.

    6. Good question. The ones I dealt with, I think it was because they were, after all, insurance companies — and thus better at hiding info than providing it.

  3. onesillyme permalink
    June 9, 2008 7:35 pm

    1) Can this be arranged so that refills just show up in my mail every 3 months, without my having to ask for it or do anything at all?

    There are some patient assistance programs that will auto-ship for up to a year. As for commercial plans, some make it easier than others. The best ones send you a reminder by mail or email & let you pop onto the website to order refills.

    2) Will I have to sign for it? What if nobody is home, because we, uh, work?

    It may depend on the cost of the drug. My experience with patient assistance for ESRD drugs is(dunno know why anyone without ESRD would want a phosphorus binder, but a 3 month supply retails for about $5k) they deliver to the MD to avoid theft. We have personally had meds delivered home without need for signature, but they were relatively cheap. You can mail order contact lenses too. I have had the signature issue come up when ordering replacement cell phones and always have them sent to work because of it.

    3) If not, what if it’s stolen out of my mailbox?

    I don’t even want to think about it! I know if you lose them or drop a pill down the drain you are SOL.

    4) What if the heat of the black metal mailbox affects the efficacy? They put those storage instructions on there for a reason.

    Supposedly they are packed to be safe from temperature variation in transit. I don’t believe a word of it.

    4) If my drug coverage provider has been bought out by Giant National Pharmacy Chain, shouldn’t my loyalty be to my employer-run hospital pharmacy? At least it’s a kind of “local” business (loathe though I am to give my paycheck *back* to my workplace).

    Another issue is whether you want ALL of your meds filled in the same place, or if you’re OK with maintenance drugs mail order and emergent/new items filled locally. If you have drug allergies or multiple medications, it’s something to think about.

    5) Why doesn’t the link to “find out more” in the email you sent me encouraging me to refill by mail actually lead me to answers to any of my questions?

    My personal (conspiracy) theory is that insurance companies in general want to make it such a pain in the a$$ to use your coverage that you give up and pay cash. My husband and I both use multiple maintenance drugs, and for some of them it is actually cheaper to bypass insurance and get the $4 Wal-Mart, etc. generic, or to mail order via a prescription assistance program. Since we spend a few hundred a month on Rx co-pays alone, it’s worth the hassle.

  4. June 9, 2008 7:57 pm

    Thank you all for this very helpful information.

  5. austinwriter permalink
    June 9, 2008 10:05 pm

    I use the mail option for my birth control via my Blue Cross Blue Shield insurance. I personally love it because I get three packs at a time and don’t have to go to the pharmacy at all anymore for it. When I’m running low on my third pack, I have to request a refill, though you can do it online really easily (you only have to mail or fax the prescription when it’s a brand new Rx). It comes via mail in a small envelope so you don’t have to worry about missing a package or a big package sitting on your door step. It doesn’t say anything about a pharmacy on the bag — it just as a PO box return address so nobody would know it is medication. Makes it pretty safe in my opinion. Not sure about the last few questions –but I bet if you call your health insurance co they can help.

  6. June 10, 2008 3:00 pm

    Those are some good questions. I wonder especially about the mail thing – it seems a large percent of drugs are either expensive, controlled or need refrigeration or something.

  7. June 10, 2008 5:12 pm

    DH gets his meds mailed to him from the VA pharmacy every 3 months, using the voice-automated system. I’ll say one thing for the VA, whatever other problems they have, their voice system has never failed us on ordering refills. He gets his insulin mailed to him, and we’ve never had a problem with it when it has had to sit in the mailbox all day. His syringes are also mailed to us, and the post office won’t leave them if no one is home (they usually either knock on the door so someone has to actually take possession of the package, or they leave a note to pick them up at the Post Office). We’ve never had any stolen, but that could be because we live in a small town (population less than 3,500), so I don’t know how the VA would react to having to replace stolen meds. On the other hand, I don’t know anyone who would have any use for Metformin, lovastatin, baby aspirin, eye drops, or insulin if they weren’t diabetic, so stealing those sure isn’t going to get anyone high (the insulin might kill them, though, if they aren’t diabetic).

  8. katbur permalink
    June 22, 2008 9:13 pm

    Rachel – First of all I love this blog, just linked it to my own. I tried the mail order pharmacy not long ago. The only problem I ran into was when I had a new prescription filled I wound up with an interaction because they did not have my regular meds on file (I needed the sleep anyway). It freaked me out enough to bring me back to my local pharmacy (which has a Plan B availability sticker on the door!!!)My advice would be if you’re only on one or two it shouldn’t be a problem but if you have regular medications for multiple issues I’d stay away.

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