MAIL-ORDER PHARMACIES: SAVING MONEY ON PRESCRIPTION DRUGS

The new information supporting the value of early treatment with AZT, together with the unconscionable price of that drug, has focused attention on the problems of paying for treatment. We will cover policy questions on cost of care in later issues; this article discusses filling prescriptions by mail to reduce costs -- whether or not one has insurance which includes drug coverage.

Mail-order pharmacies are high-volume operations which can locate where costs are low, and can negotiate good prices from suppliers. Also, they compete with each other mainly on price, because location doesn't matter, whereas traditional corner drugstores may have a captive market. Therefore they usually (but not always) have the lowest prices available. AIDS TREATMENT NEWS published price comparisons in issue #64, September 9, 1988.

For this article we briefly surveyed customer satisfaction, by asking people to tell us their own experiences with mail-order pharmacies. We did not ask the pharmacies to recommend customers for us to interview; instead we called AIDS organizations and spoke to anyone who had information, and also asked physicians and other knowledgeable people whom we were contacting anyway for other reasons. Everyone we talked to who had experience with mail-order pharmacies (about ten people in all) was completely satisfied; most of them only knew about a single one, because they were happy with the first one they tried and did not need to look further.

Yet many of the people we contacted did not know of any source for prescription drugs, even though they had talked with tens or hundreds of persons with AIDS or HIV. It seems that filling prescriptions is usually a solitary or personal activity, one which patients seldom talk about. Therefore, information about money-saving options does not circulate in the AIDS community as freely as it should. We hope this article helps to fill that communication gap.

In our interviews we did not name specific pharmacies, but let the interviewees volunteer the names. Only two mail-order prescription vendors were mentioned more than once: American Preferred Plan (APP), and Family Pharmaceuticals of America. Both had excellent references from customers. Others may be equally good; but we did not have time to make this short article into a complete list.

[Note: Readers should know that several months ago AIDS TREATMENT NEWS received an unsolicited donation of $500 from one of the companies (APP) which appears in this article. We considered returning the money in order to avoid any questions about our objectivity in future reporting. Instead we decided to accept the donation, but use it only for contributions to non- profit AIDS organizations, not for our own operations. Because of the urgent needs in the AIDS community, we felt it was better to handle the contribution this way than to return it. We also felt we should disclose the matter to our readers.]

For most mail-order pharmacies:

* Physicians can call in prescriptions, avoiding the need to wait for the mail, if patients can pay by credit card, or if the prescription is fully paid by insurance (see below). The pharmacies we talked to send the drugs by two-day express, unless overnight delivery is necessary. Delivery can be to a different street address (such as a friend's, or a work address), so that nobody needs to stay home to receive the medicines. (The couriers used, such as UPS and Federal Express, do not deliver to postoffice boxes. Also, we have not heard of deliveries outside of the United States and its possession.)

* The pharmacy should bill insurance directly and handle the paperwork. The ones we interviewed seldom or never require patients to front the money which will be paid by insurance. Some other mail-order pharmacies require full payment from the patient, with the insurance company reimbursing the patient for the percentage it pays -- a process which can take months. (Fortunately it is only necessary to pick up the phone to reach a mail-order pharmacy which does not require this money up front.)

* Patients can, of course, get price and other information by phone.

* Drugs like alpha interferon which need to be refrigerated can be shipped overnight in insulated containers. Make sure the shipper includes some kind of cold pack, such as "blue ice", able to keep the medicine cold even if a delivery is missed. (While we have heard only good reports about mail-order pharmacies, the fact remains that they are relatively new and not adequately regulated by government agencies; therefore uniform standards about such matters as shipping refrigerated drugs cannot be assumed, and patients and physicians should be vigilant.)

* While prices are usually lower at mail-order than at traditional pharmacies, they are not always lower, and it does pay to shop around.

We called the two companies named by our interviewees and asked them what advantages they offered to customers:

Family Pharmaceuticals of America, 800/922-3444 (in South Carolina only, call 803/881-3444):

This mail-order pharmacy has been in business since 1981; we first mentioned it in AIDS TREATMENT NEWS issue #46, December 1987. It is "AIDS sensitive", having long sought business in the AIDS community. It competes mainly on price but also has a good reputation for service.

In our recent interview, president John Richards, M. D., told us about new home services including intravenous medications and TPN (total parenteral nutrition). Family Pharmaceuticals has affiliated with a home-care company to deliver such treatment anywhere in the country, at what it claims are significant savings; Dr. Richards said that the first 20 patients put on this system showed savings totalling $200,000 per year, compared to what they had spent previously. Family Pharmaceuticals provides a "turnkey" system, meaning that it arranges for nursing and other necessary support, so that patients do not need to make these arrangements themselves.

Medications delivered this way can include ganciclovir, intravenous antibiotics, and aerosol pentamidine. The company also supports the "cassette" system for pain-control and other medications. This system uses a small computer-controlled pump to inject medication continuously or on a pre-programmed schedule. The apparatus and medicines can be worn on the arm; the self-contained unit is about the size of a cigarette pack.

Alpha interferon is a special case, in that suppliers have announced a cap of about $9800 that a single patient will have to pay for the drug in one year. Family Pharmaceuticals has made arrangements so that its customers do not have to front the money after this annual limit is reached.

Patients or physicians interested in home care with intravenous medications should call a special number, 800/232-3003 and ask for William J. Taylor, Pharm. D. (Dr. Taylor, incidentally, is also chair of the pharmacology committee of the Physicians' Association for AIDS Care.) Patients calling to fill ordinary prescriptions should call Kim Richardson at 800/922- 3444.

American Preferred Plan (APP), 800/227-1195 (in New York State only, call 800/445-4519):

This company is technically not a pharmacy but a membership organization; it places orders with a pharmacy, and specializes in covering the 20 percent copayment (which many insurance policies require) for its members. In most cases, APP will accept the 80 percent insurance coverage as payment in full, and the patient does not need to put out any money, or do any paperwork after they have joined the organization. There is no fee to join.

APP is very similar to Preferred Rx, which was covered in AIDS TREATMENT NEWS issue #66, October 7, 1988. However, Preferred Rx (800/365-2646; in Ohio 216/661-1977) requires a $25 membership fee every 12 months. Both Preferred Rx and APP were started by Ron English, who is also well known as a board member and major fundraiser for the Community Research Initiative in New York.

After our interviews with customers, we interviewed Ron English and Ellie Adiel at APP. This company focuses exclusively on working with people with AIDS; besides filling prescriptions, it can refer callers to organizations, agencies, legal and emotional support services, and sources of free medications.

Patients with insurance which covers 80 percent or more of the cost of pharmaceuticals should be able to fill prescriptions through APP without paying any money out of pocket. Patients without insurance can also use APP, but for them it has no special advantage over other mail-order pharmacies. Patients should compare prices on the drugs they need.

Other Options

This article does not cover free or subsidized medical care, a very important area which needs to be discussed elsewhere. Also, it does not cover any form of underground market in prescription or other pharmaceuticals.

In some locations non-profit pharmacies have been set up to reduce drug prices for persons with AIDS or other chronic diseases. We did not find any in this brief survey, but patients should know that such organizations exist.

A few traditional pharmacies have sold AZT at cost, as a public service; therefore their price is lower than that of mail-order pharmacies. We do not have a list of these pharmacies; persons should check with local AIDS support groups, which may know any in their area.

One pharmacy in Los Angeles goes beyond paying the 20 percent insurance copayment and offers cash rebates in certain situations. Will Basso at Bob's Pharmacy (6136 Venice Blvd; it also sells by mail, phone 213/838-7292) said that rebates have been as high as $300 per month, but are more typically in the range of $100 to $150, if patients are using full-dose AZT and other drugs in addition. Potential customers can learn by phone what their rebates should be before they place their orders. Basso assured us that rebates are completely legal -- "We can do what we want with our profits" -- and that they have not had complaints or problems. (AIDS TREATMENT NEWS has not yet interviewed anyone who has used this service.)

This article could not be comprehensive, and obviously many good sources for prescription drugs have not been listed. Instead of providing a list, we gave examples to show some of the options available, and to show some of the creative ways that have been developed to reduce the cost of drugs.