Gerald Katz was getting more agitated by the day.
For the past decade, the 78-year-old Cherry Hill resident had been ordering diabetic test strips by mail a week or two before he ran out and, like clockwork, a fresh box of supplies arrived within five days.
But in June, Katz, who has type 2 diabetes, encountered a problem: His new box of test strips, which he needs to check that his blood sugar level is in a safe range, was nowhere to be found.
He checked the package’s tracking number online daily, but when it stalled at a sorting facility in South Jersey, Katz went to his local post office to see what was taking so long.
“I went to the post office and they said, ‘Well, we can’t find out.’ ”
Katz had no choice but to buy test strips at a nearby pharmacy, and had to foot the bill himself because his insurer had already paid for the ones lost in the mail.
Financial challenges and operational changes at the U.S. Postal Service have resulted in late and lost mail, concerns that mail-in ballots won’t be counted in time, and, for some, delayed prescription medication deliveries. While plenty of people are still getting their packages as scheduled, others say they are waiting much longer for their prescriptions to arrive in the mail, even after the problems have drawn national attention and congressional hearings.
The coronavirus pandemic drew a wave of new customers to mail-order pharmacies, which offered a convenient way to stock up on medications while adhering to new social distancing rules. Under many insurance plans, mail order is more economical and may even be required; for others, it has been a matter of personal choice.
But now doctors worry that mail delays could jeopardize the health of patients who are counting on the Postal Service to get them essential medications. The most common types of prescriptions filled by mail order treat chronic health conditions, such as high cholesterol, diabetes, and heart problems, and must be taken daily to be effective.
“When this first hit in March, a lot of people who had a choice [of mail-order prescriptions] said ‘I’m interested now,’ ” said Jacqueline W. Fincher, president of the American College of Physicians and a doctor in Georgia. “Now the concern is: Are they actually going to get it?”
The three largest mail-order pharmacy services — OptumRX, Express Scripts, and CVS — all said they are not experiencing significant or widespread increases in customer complaints about prescription delays.
OptumRx said it works with “all major carriers to help ensure timely shipments of home delivery prescriptions” and will “continually monitor our shipments and make adjustments as needed.”
Express Scripts also said it is not experiencing any “unusual delays” in deliveries and is in contact with all national delivery carriers daily “so we know if there’s the potential for weather disruption or other issues and we adjust accordingly to ensure that patients receive their medications.”
Trey Hollern, a spokesperson for CVS Health, said the company is “closely monitoring the situation.”
CVS’s mail-order business primarily handles three-month supplies of medications for chronic health problems; these orders are mailed from a distribution center by ground or air. The pharmacy also allows customers to request delivery for orders placed with their local CVS store, which are sent through the local post office.
The Department of Veterans Affairs, which fills a majority of its prescriptions through the mail, has disputed reports of delays for veterans, and said deliveries typically arrive in three to five days, though in July delivery times averaged 2.86 days.
‘It’s just gone'
Patients tell a different story.
Stephen Johnson, 67, of Philadelphia, said the medications and supplies he relies on to manage his type 2 diabetes used to arrive within a couple days, but lately he’s been waiting almost two weeks. The most frustrating part: The CVS pharmacy that mails one of his prescriptions is just a few blocks from Johnson’s home, but he has mobility issues that prevent him from picking up the order in person.
Johnson, who worked for the Postal Service for 25 years, said he is sympathetic to the challenges his former employer is facing. “But this is medicine,” he said. “It’s a red and white box that says ‘Priority Mail.’ ”
According to the tracking number Karen Faulkner received for her prescription eye-drop order, the package bounced between sorting facilities and post offices in New York, Connecticut, and Philadelphia for 13 weeks before disappearing.
Faulkner, 55, of Salford in northern Montgomery County, orders the eye drops from an online pharmacy in Canada, where they cost about $100, compared to the more than $300 she would pay in the U.S. The deliveries typically came within four weeks and during the early months of the pandemic were taking up to six weeks — but none had ever gone missing.
Faulkner waited and waited, and when she finally called the medical supplier, “They said, ‘Well, it looks like it’s just gone.’ ”
The company agreed to resend the prescription, and in the meantime Faulkner scrounged up some samples from her eye doctor.
“I technically could go without them, but my eyes get extremely dry and itchy and irritated,” she said.
For others waiting on mail-order prescriptions, delivery delays are more than a minor irritation.
“Some of the most common drugs people have delivered by mail order are really important drugs they need to maintain their health and ensure the effectiveness of their treatment,” said Juliette Cubanski, deputy director of the program on Medicare policy at Kaiser Family Foundation. “Taking these medications daily is important to make sure they work effectively for patients and delays in mail delivery could impact their ability to adhere to their medication regimen.”
After Rakiya Venable’s 18-month-old son was recently diagnosed with asthma, the Philadelphia mother promptly ordered the medications and supplies her baby’s doctor prescribed.
She chose mail delivery to protect her family from potential exposure to the coronavirus. But as the package’s delivery date was pushed back again and again, Venable began to worry about whether it would come before she ran out of the samples from her son’s doctor.
“He’d just been diagnosed. I was trying to keep him comfortable but also say hopefully he doesn’t need [the new shipment of medication] because he only has a certain amount left,” she said.
The package eventually arrived — about a week after tracking indicated it would — but Venable won’t be using mail order for her son’s medications again. Any risk of exposure to the virus is outweighed by the risk of having to ration or go without potentially live-saving medicine, she said.
Mail order’s rising popularity
Mail-order pharmacies have steadily grown in popularity over the past several years in part due to insurance plan designs that favor them over retail pharmacies. OptumRx, Express Scripts, and CVS are all part of insurance companies that can save money by keeping prescription processing in-house. People can still fill a prescription in person, but their plan may require them to pay more than if they ordered it through the mail.
About 17% of seniors with a Medicare drug plan — some 7.3 million people — and another 6.6 million people covered by large employer health plans already used a mail-order pharmacy for at least one prescription as of 2018, according to a report by the Kaiser Family Foundation.
In the early weeks of the pandemic, mail-order use rose 20% compared to the same time last year, as people rushed to stock up on medications while avoiding unnecessary outings, according to a report by IQVIA, a health-care analytics and research company. Mail orders have since subsided and as of late July, mail-order fills were just slightly up from the same time last year.
Nick Goede, 38, of Havertown, switched to mail delivery for prescription refills in March because of the COVID-19 lockdown. The new routine worked well for a few months, but by June, deliveries that used to arrive in a day or two were taking a week.
On one occasion, the psychiatric medication refill Goede’s wife was waiting for arrived the day she took the last pill she had.
It was a close call that left Goede uncomfortable — his wife could experience withdrawal symptoms if she missed doses.
“According to the tracking they go to the post office, then go to a sorting facility, then back to the post office, then sometimes back to the sorting facility,” he said. “The whole situation is just frustrating.”
He said he plans to keep mail delivery for less critical medications, but has resumed trips to the pharmacy to pick up more important prescriptions.
After June’s test strip mishap, Katz decided to switch medical suppliers in early July. That meant getting a new monitoring device that would be compatible with the new supplier’s test strips.
Soon after making the change, the long-lost package of test strips — now useless — arrived.
Inquirer reporter Harold Brubaker contributed.