Delays in the United States mail system are leaving some people with diabetes in the lurch, unable to get their insulin and other critical medications and supplies delivered on time.

The United States Postal Service (USPS) has recently experienced unprecedented delivery delays across the nation, compounded by the continuing COVID-19 crisis that’s caused a 50 percent surge in package deliveries, creating what some describe as “Black Friday” volumes every day. In all, their handling volume increased by 708 million packages from April to June 2020.

Along with all this comes escalating concern about the November presidential election, which will see unprecedented numbers of people voting by mail, further challenging the delivery infrastructure.

Of course, people with diabetes (PWDs) and other health conditions who rely on mail-order prescription meds and supplies are feeling the effect. One market research poll found 1 in 5 Americans got their medications by mail during the final week of August, and a quarter of those people experienced a delay or non-delivery.

More than 20 national health groups — including JDRF, the American Diabetes Association (ADA) and the Association of Diabetes Care and Education Specialists (ADCES) — sent a letter on Aug. 25 to USPS Postmaster General Louis DeJoy, who took that role earlier in 2020 and has been in the hot seat over the mail delivery delays and issues.

The groups expressed concern over current delays and called on DeJoy to reinstate the USPS delivery standards in place prior to his taking the job. Among the changes he made were restricting overtime and cutting back on mail sorters who helped deliver items on time.

“While we appreciate that you (DeJoy) have committed to halt the changes implemented earlier this summer, we believe more should be done to curb any damage to Americans, including those with a medical condition,” the letter stated. “In order to ensure the safe and timely delivery of critical medications, we urge you to restore altered package operations and reinstate delivery standards to ensure timely delivery of packages. By going further than suspending the changes and returning to the status quo, we can ensure that all Americans get the access to the health supplies they need.”

The ADA told DiabetesMine they have heard from many PWDs who receive meds and supplies mailed to them directly, who are now facing issues related to USPS delays. Here are some of the examples the ADA provided:

  • A woman with type 1 diabetes (T1D) shared that her insulin is normally shipped refrigerated and supposed to be delivered overnight, and that her pump supplies and testing supplies are all delivered via USPS. Her husband and daughter both have asthma and their medications are delivered via USPS as well. She says each package sent to them over the last 2 months is taking longer and longer to arrive.
  • One PWD mentioned ordering test strips on July 7, but they did not arrive until the last week of August — a full 7 weeks later.
  • Someone from a suburb of Philadelphia says their diabetes medicine is now taking 3 weeks to arrive instead of the usual 3 days.
  • Another said their mail-order meds were sent out almost a month ago in late July but still hadn’t arrived as of late August.
  • In Los Angeles, another PWD shared that their medication took 3 weeks to arrive from Seattle — 2 days with UPS and the rest of the time delayed locally with USPS.
  • Another woman told ADA about delays with her CGM delivery. Luckily she had a backup, but had that not been the case, it would have been a problem.
  • Many retired military members rely on mail-order as part of their Veterans Administration (VA) coverage (news publications capturing those PWDs’ stories are becoming more frequent in recent weeks).

One of those impacted is Jennifer Draney in Utah, who lives with T1D along with her 19-year-old son, and she also leads that state’s #insulin4all advocacy chapter.

Her teen son Spencer, one of six kids, was diagnosed in April 2017. Two years later, this D-Mom faced her own health reckoning following an initial T2D misdiagnosis before her eventual correct diagnosis of T1D. With two insulin users in the household, that’s quite a lot of supplies and insulin needed. Over the years they’ve managed to navigate employer-based coverage, Medicaid, the Affordable Care Act marketplace, and no insurance.

“With each one of these plans, the insulin and supplies that are needed daily to live are absolutely financially crippling,” Draney told DiabetesMine.

“I have begged for insulin and supplies for my family and I have given unused donated insulin and supplies to many people and families myself. This has saved so many people, but unfortunately… we cannot reach every T1D rationing their insulin and supplies,” she says.

She and her son rely on mail-order to obtain pump and CGM supplies, and she says Spencer recently had to wait several weeks for his Dexcom supplies, which were late because of FedEx and USPS shipping delays.

“When it comes to the USPS sabotage, I feel so vulnerable,” she said. “I am a fighter all the way, but this one has been extremely hard.”

The impact is also felt directly by insurers and diabetes device companies, of course.

A Bloomberg Government story in late August reported that large pharmacy chains like Walgreens and Pharmacy Benefit Managers (PBMs) like OptumRx and Express Scripts say their mail-order prescriptions are generally not seeing delays, as they are largely outsourcing to FedEx and UPS to complete deliveries from start to finish.

Both UPS and FedEx Ground say they have improved back to pre-pandemic levels, but customers are still experiencing delays in certain parts of the country. And a rush of new customers could easily create bottlenecks at any moment.

Big device manufacturers like Medtronic and Dexcom and many of the third-party distributors also rely largely on private carriers, but it is common practice to hand off the final leg of the delivery to local USPS, and that’s led to some delays.

Diabetes startup One Drop in New York is one that depends on mail-order to get glucose meters and test strips out to their customers. Since March, the company has seen a 1.2-day increase in the time it takes for USPS to deliver supplies — from 3 days to 4.2 days, the company tells DiabetesMine.

To navigate those delays, One Drop has moved away from some shipping services like UPS Mail Innovations that hand off packages to the local USPS carriers for the final leg of delivery. More packages are being routed through first-class delivery, which has been more consistent, and the company has also launched a less expensive 2-day shipping option.

“One Drop customers, like many of us, rely heavily on the USPS to get their healthcare supplies,” says One Drop’s Doug Kern. “We’ve been working closely with our fulfillment providers and carriers to watch cycle times and shift as needed so that packages get reliably delivered.”

Here’s a rundown of what some experts some suggest doing to avoid or work around these mail-order med delays in case you are impacted. Insurance coverage varies of course, so you’ll have to determine which tactics are best for you.

  • Plan ahead. Keep close tabs on refill dates for meds and supplies, or whether you’re at the point where you’ll first need a new prescription that requires extra time. In Hawaii, D-advocate Corinna Cornejo who lives with T2D says her healthcare company suggested refilling an order when there’s only 1/3 left, and to follow-up if you haven’t received it within 14 days.
  • Request backups. Some diabetes clinics and doctors say they’ve received more requests from patients in 2020 for backup vials or insulin pens, due to mail-order shipping delays. While not all doctors are able or willing, many do have backups on hand that they can share with patients in need.
  • Ask for priority status. When ordering supplies directly from manufacturers, you can request priority shipment status because it’s a medical supply. Some may charge more, but some companies like Dexcom have allowed this to avoid delays beyond the typical 3 to 5 days for a CGM sensor order.
  • Switch to a pharmacy. Despite their contracts with mail-order services, some insurers are now allowing PWDs to fill prescriptions at a local pharmacy to avoid delays. Earlier in 2020 when the COVID-19 crisis was kicking into high gear, various insurers and PBMs like Express Scripts and Blue Cross told DiabetesMine they were relaxing rules on medication access. Oftentimes they allow a 30-day supply at a local pharmacy versus a 90-day supply via mail-order, so check your own coverage plan for details.