Most of us say "thanks" without thinking.
Aug. 21--Home delivery isn't just for newspapers, clothing and gifts on wedding registries anymore.
The region's major health insurers are making it easier for their members to have medications mailed or delivered to wherever they live.
The insurance companies are linking up with national mail-order firms, big drugstore chains and independent local pharmacies to provide the free service, which has been offered for years but is now more widely available and a focus of the companies' marketing efforts.
"The market is demanding that we offer this to our membership," said Mona Chitre, Univera Healthcare's vice president of pharmacy management.
The insurers say members and their employers increasingly want the option of mailed or delivered drugs, citing the convenience and savings. Univera officials also believe people who have their medications delivered are more likely to use them as directed by their doctors, leading to better management of chronic conditions.
But not everyone is sold on the value of mail-order or home-delivered drugs.
Independent pharmacists fear that the out-of-town, mail-order companies are a threat to their business. Others are skeptical that delivery will lead patients to stick better to a prescribed course of medication, and they believe patients are better served when they can meet face to face with a pharmacist.
"Do you go to mail order for your physician, or your dentist or anybody else?" said Karl D. Fiebelkorn, senior associate dean for student, professional, and community affairs at the University at Buffalo's School of Pharmacy and Pharmaceutical Sciences.
Independent pharmacies were among the first to offer home delivery, for free, as an extra service and a way to compete with the larger chains. At Family Medical Pharmacy in Amherst, for example, an employee delivers medications to patients, who are asked to call the pharmacy if it is a first-time prescription.
Co-owner Dennis Galluzzo said only about 10 percent of his customers take advantage of that option. "I believe they like seeing us," said Galluzzo, who is executive director of the Pharmacists Association of Western New York. "I know their name -- it's like 'Cheers.'"
Independent Health offers mail-order prescriptions through Wegmans and Walgreens Mail Service Pharmacy, and only about 1 percent of their members use the service, which started in 2003. The insurer also fills specialty prescriptions that are delivered to patients' homes through an affiliated company, RelianceRx.
And the insurer offers home delivery through a contract with a network of community pharmacies. Whether they sign up for local home delivery through community pharmacies or out-of-town mail orders, members will pay 2 1/2 co-pays instead of the standard three co-pays for a three-month supply.
"It's a level playing field for both," said Marty Burruano, Independent Health's vice president of pharmacy services.
BlueCross BlueShield, for its part, offers mail-order prescriptions through Express Scripts, a national provider of prescription drug benefits.
And Univera expanded its mail-order program, which started with the national provider Primemail, to add Wegmans pharmacy as of Aug. 1.
Wegmans serves mail-order Independent Health and Univera members from a pharmacy in the Buffalo area, where prescriptions are filled and shipped out. That program isn't meant to replace its in-store pharmacies, said Jack Coultry, the grocery chain's manager of managed care.
Instead, he said, the service frees up its pharmacists to spend more time on clinical programs and patient counseling.
"We want to be a full-service pharmacy," said Coultry. "The store pharmacies still play a very critical role."
As with the other delivery options provided through the insurers and the independent pharmacies, Wegmans customers don't pay anything extra.
Univera said it has seen a low level of mail-order adoption by its members, but the company is promoting it as a time- and money-saving option.
Chitre said mail order isn't recommended for antibiotics or other one-time prescriptions, but it works well for drugs that are meant to be taken for months or years at a time to treat chronic medical conditions.
In fact, Univera officials believe patients who have their medications shipped to their homes are more likely to take the drugs, as directed, and this added adherence can save money. The American Heart Association estimated that failing to take medications as prescribed leads to 125,000 patient deaths and costs $300 billion annually in additional emergency room trips, doctors' office visits and hospitalizations.
"Some people just have barriers to get them to the pharmacy every month," Chitre said.
Independent Health's Burruano said the insurer hasn't seen this effect among its mail-order members. And UB's Fiebelkorn said he believes there is more potential for waste if, for example, patients order a 90-day supply of drugs and stop taking them because they have a bad reaction to the medicine.
Further, medication often is exposed during the shipping process to high or low temperatures, which in the extreme can make some drugs less effective.
Fiebelkorn said his pharmacist colleagues regularly see mail-order customers coming into their stores to complain of medication that arrived frozen -- or not at all.
Wegmans, for its part, keeps an eye on predictions of extreme weather or temperatures when shipping its medications, and drugs that have to be refrigerated routinely are shipped overnight in a special cooler with ice packs, Coultry said.
The local pharmacists also expressed concern about patients not discussing a new medication with a pharmacist.
The mail-order providers all offer 1-800 numbers for patients to call with questions, but critics say it can be hard to get a pharmacist on the phone and patients don't have many other options. "Your mailman isn't going to tell you what you need to know about your medication," Galluzzo said.
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