Medicine by Mail It's cheaper, but critics say it can complicate important safeguards

August 31, 1993|By Linell Smith | Linell Smith,Staff Writer

Like many elderly Americans, 80-year-old Donald Wilson of Catonsville keeps healthy with a daily regimen of medication: There is a pill and skin patch to control high blood pressure, pills and eye drops for glaucoma, a pill for cardiac arrhythmia and ointment for a pre-cancerous skin condition.

Because Medicare does not pay for outpatient prescription drugs, Mr. Wilson is acutely aware of the expense of his medication. The retired banker has discovered a way to save money -- and a trip to the drugstore -- by ordering his drugs over the phone from AARP Pharmacy Service, a mail-order company.

Drugs through the mail?

More consumers are using mail-order pharmacies because they can offer savings on drugs that treat such chronic conditions as heart disease, high blood pressure and arthritis. These large businesses purchase bulk quantities of drugs -- often generic -- which enables them to charge lower prices than independent and chain drugstores.

Although mail-order pharmacies claim only about 6 percent of the nation's retail prescription market, according to Stephen Schondelmeyer, director of the University of Minnesota's Pharmaceutical Research in Management and Economics Institute, the industry is causing more than its share of consternation in the health-care world.

You might consider it the debate of price vs. service.

"Mail-order pharmacies are cheaper, there's not much doubt about that," says Dr. Gary Applebaum, medical director of Charlestowne Retirement Community and assistant professor of geriatric medicine at Johns Hopkins School of Medicine. "But can you ask questions to your mailman when he brings pills to you?"

Mail-order pharmacies keep computerized medication profiles of their clients and provide a toll-free phone number to call a pharmacist with any questions they might have. Some companies employ as many as 100 pharmacists at a single facility, says Del Konnor, executive vice president of the American Managed Care Pharmacy Association, which represents the largest mail-service pharmacies.

"An 800 number leaves the burden of initiating the consultation on the patient," says Dr. Schondelmeyer. "I would hope that the pharmacist should initiate the process. An 800 number isn't the same as saying 'A pharmacist has reviewed your medication history and advised you as far as what you need to know.'"

Ideally, a pharmacist keeps track of all the drugs a patient is using so he can counsel him, screen for potential drug TTC interactions and monitor whether he is taking the medication properly, says David Knapp, dean of the School of Pharmacy, University of Maryland at Baltimore.

A pharmacist can serve as an important medical adviser: Approximately a fourth of all hospital and nursing-home admissions for the elderly are related to patients not taking their medication correctly, according to a recent issue of Hospital Pharmacy and Managed Care.

Mr. Wilson says he has never needed to talk with a pharmacist from the AARP about his drugs. "I've relied entirely on my doctors to advise me on the medication," he says.

He also depends almost exclusively on the mail-order pharmacy for all of his prescriptions. However, many consumers use more than one pharmacist -- a practice which makes it difficult to assemble a complete portrait of their drug use. Although people may order chronic medications by mail, for instance, they still purchase acute-care drugs such as antibiotics from neighborhood druggists.

"Let's say someone is on Theo-Dur, a maintenance drug used to control asthma," says Dr. Applebaum. "He goes to a doctor not familiar with his history with a case of bronchitis and the doctor gives him an antibiotic, say, erythromycin. He goes to the local pharmacy to get that. That pharmacist doesn't know that the person is also on Theo-Dur from a mail-order pharmacy. The erythromycin can potentially interact with Theo-Dur in such a way that you could have seizures or rhythm disturbances of the heart."

Ordering medication by mail also means the patient must plan ahead.

"Most people seem to run out of medicine on a Sunday afternoon when their doctor is not available," says David Miller, executive director of the Maryland Pharmacists Association. "If your prescription is on file with a mail-order company and the local pharmacy does not have a copy, they cannot legally give you any medicine. You have to have a new one written out or phoned in to the local pharmacy until your medicine comes in."

Independent pharmacies also offer services, such as free home delivery and charge accounts. These amenities may also contribute to higher prices at these drug stores.

With the lower prices of mail-order drugs, consumers may wonder whether the medication is of the same quality they find at their neighborhood pharmacy.

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