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Drugs by Mail: Money Saver or Rx for Disaster?

By Fred Yager
ConsumerAffairs.com

October 5, 2006

Pharmacy Benefit Managers • Study Finds Mail Order Prescriptions No Bargain • Drugs by Mail: Money Saver or Rx for Disaster? • PBMs Come Under Tougher Scrutiny -- • Caremark • Express Scripts • Medco

You're tired of standing in those long lines at the prescription drug counter each month and thinking about taking advantage of "prescriptions by mail" offered by your health insurance company.

You've read the literature promising you'll not only save time and money, but that dealing with the plan's pharmacy benefit manager -- or PBM -- you'll have fewer errors and even more privacy than you would using retail drug outlets.

If that's the case, what went wrong for these customers who had a distinctly different experience?

Donna of Carrollton, Texas said she had to fight with her drugs by mail company to get her prescription filled but only after her doctor charged additional fees for having to deal with the mail order pharmacy and completing addition forms.

• Tablet Splitting: A Risky Practice • FDA Moves on Drug Counterfeiting • Bill Banning Drug "Pay-For-Delay" Gets Hearing • Drug Costs Rise Less Quickly, Study Finds • Coping With Costly Prescriptions • Proposed Settlement Could Lower Prescription Drug Prices • FDA: Baltimore Pharmacies Selling Expired and Counterfeit Drugs • Some Drug Prices Surging 100 Percent Or More • Kmart, Schnucks Expand Generic Rx Discounts • Coming Soon: Generic Drugs from China • Safeway Introduces Generic Drug Discounts • Medicaid Cuts 'Devastating,' Pharmacies Warn • Kroger Expands Its Generic Drug Discount Program • Supermarkets Launch Generic Drug Discount Programs • Drug Prices Can Vary Widely, Survey Finds • Wal-Mart Adds More Generic Drugs To Discount Plan • FDA Finds Problems with Online Drugs • Wal-Mart Expands $4 Generic Program • Walgreens.com's Pharmacy Gets Top Rating • Popular Blood Pressure Drug Goes Generic • Wal-Mart Expands Generic Drug Plan • Consumers Get Little Drug Price Information From Their Doctors • Florida Pharmacy Offers Generics Online for $3.79 • Wal-Mart Adds 12 More States To $4 Drug Program • Wal-Mart Expands $4 Generic Drug Program To 14 More States • Report: Shopping Around Beats Medicare Drug Prices • Drugs by Mail: Money Saver or Rx for Disaster? • Wal-Mart Expands Its Generic Drug Discounts • Feds Give Up on Canadian Drug Crackdown • Target Matches Wal-Mart's $4 Generic Rx Price • Congress OKs Drug Shopping Trips To Canada • Seniors Bemoan "Donut Day" • Wal-Mart Cuts Generic Rx Prices To $4 In Florida • AARP: Drug Prices Still Rising • Illinois Sues 48 Drug Companies • Pharmacy Benefit Managers Scrutinized • Survey Shows Value of Comparison Shopping

Fred of Ithaca, New York, said his PBM had denied a request that his rheumatoid arthritis medicine not be sent via commercial courier because the drug, Humira, must be kept between 36 and 46 degrees Fahrenheit or it loses its therapeutic ability. He even told them it would only take one compromised batch (even a one or two week supply) to cause irreparable damage to his health and ability to function.

Then there was Matthew of Fort Wayne, Indiana who mailed Medco a prescription for his wife for Advair at a dosage of 250/50. Later that same day his wife's doctor changed the prescription to a dosage of 500/50. So he called the PBM, advised them of the change and told them to cancel the 250/50 prescription.

A week later, the wrong prescription arrived at a charge of $120. So much for fewer errors.

Still, despite the constant complaints similar to those above, the mail order pharmacies continue to fill millions of prescriptions and a good many of them arrive without incident. The key to having a better outcome with buying drugs by mail, is to make sure you fall into a particular category -- simple and repetitive.

The PBMs are good at filling the same order over and over on a monthly -- or, even better, a 90-day -- schedule. Exotic drugs and rush orders often don't work out well.

In other words, prescription drugs by mail tend to work best if you have a long-term chronic condition such as high blood pressure or high cholesterol where the prescription is fairly well established and the dosage doesn't vary. If you don't fall into that category, ordering drugs by mail could turn into a migraine headache.

There's also an argument that mail order drug prices are not necessarily lower. With Wal-Mart's aggressive new pricing in Florida, and Target's me-too attitude, there's a new competitive attitude in drug pricing. Besides Wal-Mart and Target, Costco offers a generic version of Prozac that could be less expensive than your mail-order prescription.

But not everyone is in driving distance of a Costco or Wal-Mart, which may make the PBM the best answer.

A typical mail order plan gives you a 90-day supply for just over twice the cost of a co-payment for a 30-day supply at the drug store and without a shipping fee.

The main drawback with mail order drugs is the loss of personal one-on-one contact with a local pharmacist who can deal with problems quickly. Most complaints regarding PBM's or "pharmacy benefit managers" involve changes in dosage, failure to handle special circumstances, and the time-consuming effort to correct an error.

So if you are considering ordering drugs by mail, you may want to get your first 30 days supply from a local drug store just to make sure there are no problems with the prescription.

Buying drugs online from websites you've never heard of is another story altogether.

It's very risky and you have next to no recourse should things go wrong. There's a good chance the drugs you get aren't really the drugs you ordered and they could even hurt you.

So if you are thinking about buying drugs by mail, make sure you know who you're buying them from and steer clear of websites promising discounted prices. They'll most likely cost you more in the long run.

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