August 20, 2020 In the News

U.S. Mail Delays Slow Delivery of Medicines

The New York Times
By Reed Abelson
August 20, 2020

To many people who rely on the mail to deliver their prescriptions, the latest political skirmishing over the U.S. Postal Service doesn’t really matter. They’ve been dealing with delays for weeks, and while some are not urgent, others are more worrisome.

Dr. Toula Milios Guilfoyle, a retired physician in Jefferson, N.H., is among those who say their mail-order prescriptions have become dangerously late. Dr. Guilfoyle, who is 62 and disabled, needs antibiotics for a chronic infection. While her prescriptions from the Dartmouth-Hitchcock Medical Center usually arrive a few days after they are sent, last month she had to wait two weeks to receive them, and subsequent prescriptions have also been delayed.

Without the antibiotics she needed, her infection spread. “I got worse and worse,” she said.

She initially thought the first delay was “a fluke,” but her prescriptions have been late two more times. “Everything has slowed down,” Dr. Guilfoyle said. She worries that the reports of the removal of mailboxes and postal equipment that have already taken place will continue to make the delivery of mail sluggish.

Most of the criticism over the cost-cutting actions taken by Postmaster General Louis DeJoy, a major donor to President Trump, has focused on whether the measures could jeopardize mail-in voting for the upcoming election. But there is increasing recognition of the effect the cutbacks would have on consumers who receive their medicines via the mail.

Nearly one in five Americans said they received medications through the mail last week, according to an Axios-Ipsos poll released Aug. 18. Of those, a quarter said they experienced some delay or lack of delivery.

Although only 5 percent of the nation’s retail prescriptions were delivered to consumers by mail last year, the Postal Service handled perhaps half of the volume, some 100 million prescriptions, by one estimate.

But use of mail order for prescriptions rose by 20 percent when the U.S. outbreaks spread in March, compared with the previous year, as people stockpiled medications during lockdown.

In addition, many of the drugs shipped are critical medicines for people with chronic conditions like diabetes or high blood pressure.

“It’s just unacceptable for the Senate to be in recess while prescriptions continue to sit in sorting facilities,” said Senator Jeanne Shaheen, a New Hampshire Democrat and one of the lawmakers Dr. Guilfoyle contacted. “More than 3,000 constituents have contacted my office recently about Postal Service delays, and they can’t afford to have the Trump administration playing politics with their mail and their medications.”

Doctors and pharmacists also expressed their apprehension about patients not getting their prescriptions in a timely manner, especially when many are advised to stay at home during the coronavirus pandemic.

“Any disruption in the U.S. mail is of concern,” said Dr. Jacqueline Fincher, the president of the American College of Physicians, which represents internists. “Patients are being put at risk for no good reason, it would seem,” she said.

Missed doses could cause adverse health issues.

“If they go without for several days, the concern is always ‘Are you going to have a bad outcome?’” said Dr. Fincher, who warned patients might need to go to the hospital if their conditions significantly worsened. “This is not the time you want to be in the hospital for one of your chronic conditions that is out of whack.”

Even though Mr. DeJoy announced earlier this week that he would suspend some of the changes, Senator Gary Peters, a Michigan Democrat, plans to hold an oversight hearing on Friday to question the postmaster general.

“It’s clear that the policies directed by Postmaster General DeJoy have hurt people who use the Postal Service as a lifeline for everyday needs, including Michigan seniors and veterans and people in rural communities who rely on live-saving prescriptions they receive in the mail,” Mr. Peters said.

House Democrats are also scheduling a vote on Saturday on legislation that would revoke changes Mr. DeJoy has already made, and include $25 billion in funding for the agency.

Veterans have been particularly affected by mail delays because the Department of Veterans Affairs relies on the Postal Service for delivery. Jan Stowe, 74, of Traverse City, Mich., said that in July, for the first time, she did not get her prescription before she ran out of the Valium she takes for chronic muscle spasms. She suffered acute pain for four days, she said. “This medicine is to me lifesaving because it keeps me upright and mobile,” Ms. Stowe said.

Exactly how many people are being affected is unclear. The major pharmacy benefit managers, including CVS Health, Express Scripts and OptumRx, will only say they are closely watching the situation.

Some pharmacies say they are seeing some delays, like AllianceRX Walgreens Prime, which is operated by Walgreens, the drugstore chain, and Prime Therapeutics, a pharmacy benefit manager. Delays of three or more days have been reported, although the partnership said their customers were not suffering from any disruption in treatment.

“There has now been a noticeable difference,” said Dr. Jessica Nouhavandi, a pharmacist and a founder of an online pharmacy, Honeybee Health, which says it has 50,000 customers. While there are competing services like UPS or FedEx, the Postal Service “is by far the most cost-effective option for our patients,” she said, and other shipping companies depend on the U.S. mail service for the last leg of a delivery.

Honeybee’s rate of lost packages rose to about 5 percent in July from an average of less than 1 percent in February, Dr. Nouhavandi said. Prescription packages shipped via first-class mail took an average of 11 days, compared with just four or five before.

“Once it leaves our facility, it really is out of our control,” she said. The pharmacy is considering recommending that patients pay more for two-day delivery to ensure they get their medications on time.

While the number of patients relying on their mail “is not trivial,” a vast majority of patients are likely to be unaffected because they get their prescriptions through retail pharmacies, said Adam Fein, the chief executive of the Drug Channels Institute, which analyzes the distribution of medicines. He calculates that of the 5 percent of prescriptions in 2019 that were delivered by mail, 55 percent used the U.S. mail because the type of medicine did not need special handling.

Although some patients turned to mail order because of the pandemic and the concern about leaving their home to go to a pharmacy, Mr. Fein said these delays were not likely to have a widespread effect on patients because most health plans allow people to refill a prescription early or go to a pharmacy if they run out. “There’s really very little likelihood that people would not get access to prescriptions,” he said.

The Medicare Rights Center, a consumer group, suggests people who switch should still try to reduce their risk of exposure to the virus by choosing a retail pharmacy that offers home delivery or curbside pickup. It also recommends people check their health plan to make sure they have the option of a retail pharmacy and to see how much their medications will cost if they make the change.

And not everyone has easy access to a pharmacy, said Dr. Scott J. Knoer, a pharmacist who is the chief executive of the American Pharmacists Association. Many urban and rural areas have “pharmacy deserts,” he said, where residents do not live near a drugstore.

All of this makes patients and their families anxious, said Laura Hatcher, the director of communications for the Little Lobbyists, a group representing children with complex medical needs. “We’re just starting to see people have real issues with the mail,” she said.

Many of the medications these children need may not be available at the local drugstore, because they are a controlled substance or must be individually compounded. If there are delays at the Postal Service “then it will be an enormous problem,” Ms. Hatcher said.