The Mail-Order Prescription Drug Industry

Abstract

THE PRACTICE of mailing prescription and other medications to consumers in the United States probably had its origin in rural America. Before the general availability of the automobile, rural inhabitants often were dependent upon the U.S. mail for delivery of medicines and health supplies from their local pharmacy. This practice was not only a convenience to the consumer, but an essential health service as well-one in which physician, pharmacist, and patient were active participants. The Veterans Administration has used the mails for distributing medicines to its ambulant patients for many years. This practice was expanded greatly with the return of veterans after World War II and has continued to grow, proving convenient and economical for both parties. In more recent times, the National Retired Teachers Association and American Association of Retired Persons (NRTA-AARP) has been distributing prescription medications to its members through a program that is now a featured service. As the volume of prescriptions delivered by mail has increased, the practice has come under continuing, and at times critical, surveillance, particularly by organized pharmacy. Because available information to characterize the nature and extent of the mail-order prescription industry has not been collected and scrutinized, we undertook to assemble as much factual information as could be obtained. Professional organizations and State boards of pharmacy were contacted for the names of firms engaged in high-volume, mail-order distribution of prescription drugs. A list of approximately 60 organizations was compiled. Data were then collected through a combination of personal and telephone interviews from 10 of the larger organizations, using a standard set of questions relating to the data reported in the remainder of this paper. These organizations are responsible for approximately 90 percent of the volume of mail-order prescription drugs in the United States. This report constitutes a profile of the mail-order prescription drug industry as constructed from our study. For purposes of convenience, mail-order Dr. Wertheimer and Dr. Knoben were formerly on the stafi of the Pharmacy-Related Programs Branch, National Center for Health Services Research and Development, Health Resources Administration. Dr. Wertheimer is now associate professor, University of Minnesota College of Pharmacy; DP. Knoben is now at Yale University. Tearsheet requests to Dr. Albert I. Wertheimer, University of Minnesota College of Pharmacy, Minneapolis, Minn. 55455.