Researchers at Kaiser Permanente have added to a small but growing body of research that some believe reinforces the benefits of getting prescriptions through the mail.
The latest study, published in the American Journal of Managed Care (AJMC), followed more than 17,000 patients with diabetes in the Kaiser Permanente system. Those who had heart conditions and received medications by mail had a modest, 7-percent less likelihood of needing to visit the emergency room than those who got them from a pharmacy.
During a three-year period, 40.2 percent of patients who obtained their drugs from a brick-and-mortar pharmacy ended up in the trauma center. Only 33.8 of those who got their medications by mail made a trip.
“Mail-order pharmacies can increase access to medications for patients, especially for patients who have constraints on time or availability of transportation,” Julie Schmittdiel, a Kaiser Permanente research scientist, told Healthline. “Our study was the first to see if there were any cons to mail-order pharmacy in terms of patient safety issues, and we found no major concerns.”
The Pharmaceutical Care Management Association, which represents pharmacy benefit managers nationwide, applauded the Kaiser study. “Improving medication adherence also means lower overall health care costs,” Mark Merritt, the organization's president and CEO, said in a statement.
Pharmacy benefit managers, or PBMs, administer the pharmaceutical needs for about two-thirds of Americans. The own or control several aspects of the industry, including many of the mail-order providers.
Better Service With Bricks and Mortar?
A representative of the National Community Pharmacists Association (NCPA) told Healthline that Kaiser Permanente is a standout in the delivery of mail-order medicine and always receives high marks from customers compared to other mail-order pharmacies.
But a recently released J.D. Power survey of pharmacy satisfaction shows that, overall, brick-and-mortar pharmacies are outpacing the mail-order option which once reigned supreme.
"For the most part, the widening gap in satisfaction has more to do with improved satisfaction in the brick and mortar segment than declining satisfaction in mail-order,” Scott Hawkins, director of the healthcare practice at J.D. Power, said in a press release. “For mail-order pharmacies, it's important to combine high-tech with high-touch. Not only does the online experience need to keep technological pace with other retail sites that pharmacy customers visit, but customer service opportunities that provide personal connections are essential as well.”
Kaiser Permanente does that. “Kaiser Permanente does have pharmacist telephone support available for all patients filling medications, either through mail order or through 'brick and mortar' pharmacy outlets,” Schmittdiel said. “I don't know how widely this option is available through other mail-order pharmacy services.”
Kaiser customers can order their mail-order medications by phone or online. Co-payments are often lower for those who select the mail-order option.
Cost-savings have long driven the popularity of mail-order prescriptions, but the J.D. Power survey shows that the advantage has tilted sharply toward traditional pharmacies since 2011, when the last survey was conducted.
More Research Needed
Previous research by Schmittdiel has demonstrated that patients can achieve better cholesterol control when they receive their prescriptions by mail. She also has shown that the mail-order method results in better medication adherence.
Such studies have also been conducted within the Kaiser system in northern California. Kaiser is able to conduct such studies because it has the largest patient-centered medical records system in the world, according to AJMC.
Kevin Schweers, the vice president of public affairs at NCPA, said that Kaiser's 9.1 million patients represent only a small portion of Americans, and that comparing its superior delivery to the rest of the mail-order industry is “apples and oranges.”
“Patient choice and preference are very important in making optimal medication-taking decisions,” Shmittdiel said. “We do feel that more research should be done to help us understand who might benefit most from using mail-order, and how to best encourage and educate patients on how to use mail-order pharmacy services if they are interested in doing so.”