The merger of Express Scripts and Medco gives us even fewer choices for mail-order pharmacy options where patients can receive 90 days of their prescriptions at a time. Receiving 90 days at a time has been great for my patients in many ways, but there are some instances where it doesn’t work. For those times, you will need to find a local pharmacy to help you out. Here are the 10 issues my patients and I run in to where mail-order pharmacies aren’t so good.
1. You need something and you need it now: Antibiotics for a sinus infection, cream for a rash, treatment of a urinary tract infection, and the list goes on. You will need this the same day and your mail-in won’t help you there.
2. Fluctuating doses: I have many patients on high blood pressure medications, for example, where we are changing the dose around. Weight loss and exercise among other things can lower your blood pressure, and we may be able to lower the dose of your med. If we’ve been tinkering with your dose, a 30-day prescription may serve you better than filling a 90-day prescription only to toss it in the trash.
3. We aren’t sure it’s going to work for you: Migraine medications, allergy medications and heartburn medications that we start on you may not work. If they don’t work (bummer) you will be tossing those pills in the trash. Thirty days for a new medication you are trying out makes more sense.
4. It’s new and you may experience side effects with it: I have started patients on antidepressants, urge incontinence meds, blood pressure meds, only to have them tell me the dry mouth/dizziness/fatigue is intolerable. Then you are stuck tossing out 90 days of pills.
5. Start low, go high: Again, for antidepressants, pain medications, and meds for neuropathy, among others, I like to start a low dose for 2 – 3 weeks then increase it. This way you may tolerate the medication better and we can see how high we need to go for effect. Three-month supplies don’t work well for this.
6. You need it short term: If you only need 14 pills of zolpidem before you leave on your trip, a local retail pharmacy will suit you better.
7. Human contact: If you want to talk to your pharmacist about drug interactions or side effects, your local pharmacy fills that need best.
8. Human voice: If there is a problem (you get the wrong size needles for your insulin, for example) or if you have a customer service issue, I have heard from patients it is very difficult to get a voice on the phone to help you out. In fact I’ve heard it can be a nightmare with the mail-in pharmacies.
9. Slower to get generics: Mail-order pharmacies are slower to get generics and dispense 10 – 13% less generic medications than retail pharmacies.
10. You don’t have the 10 – 14 days to wait.
What did I miss?