Are mail-order prescriptions needed for employer-based health plans?

We wrote recently about the rapidly growing business of mail-order pharmacies run by the pharmacy benefit managers (PBM) who work with employer-based insurance providers.

It’s been a trend with no small hint of irony. You see, when Canadian mail-order pharmacies came on the scene in the 90s, representatives of Big Insurance and Big Pharma trashed the whole idea of the mail-order pharmacy. They said it was unwise — even dangerous — to order drugs without having face-to-face contact with your pharmacist. They said your relationship with your pharmacist was just as important as the one you have with your doctor.

All that would be lost, they said, if you ordered from an online pharmacy. Of course, now that they’ve figured out how to make a buck off of the idea, they love it.

And now, Big Insurance is moving toward a day when you may actually be forced to order your drugs online or through mail-order — whether you like it or not.

As U.S News reports:

Express Scripts, one of the nation’s largest pharmacy benefit managers, has developed a program [called] Select Home Delivery [that] automatically enrolls employees in the home delivery program unless they specifically opt out of it …

That’s right. If your employer’s PBM is Express Scripts, and they sign up for Select Home Delivery, mail-order will be the default option for all employees.

Mark my words here; this is the first of several shoes to drop. Up next:

  1. Soon, all other PBMs will offer the same program.
  2. Then, one PBM will come up with a program that makes participation in the mail-order program mandatory in order for employees to receive coverage — in the name of employer cost savings.
  3. That will become the dominant model for employer-based prescription drug insurance.

Now, I haven’t factored in the uproar that this would cause with the Wal-Marts, Rite Aids and the like. Some kind of accommodation will probably have to be reached to make all the big-money players happy.

And of course, consumers won’t like it, because no one likes having their choices taken away. But how much power do consumers have these days in the face of Big Insurance and Big Pharma, anyway?

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When you listen to Express Scripts tout the benefits of Select Home Delivery, you know it’s only the beginning:

“Moving from retail to home delivery may be the most powerful intervention we have today to improve therapy adherence,” says Bob Nease, chief scientist for Express Scripts, referring to patients who follow their prescribed drug regimens. Home delivery also saves patients money, typically up to a third of the prescription cost for a 90-day supply.

So far, about two dozen companies have signed up for the Select Home Delivery program. Home improvement retailer Lowe’s has seen the percentage of prescriptions filled through home delivery rise from about 14 percent to 40 percent since the company signed on, says Nease.

As you know, we at are big fans of online and mail-order pharmacies. We were fans of mail-order pharmacies long before the insurance companies.

We know that mail-order pharmacies save healthcare consumers money. And we’re glad that millions of consumers will learn through programs like Select Home Delivery that they need not be scared of ordering drugs through the mail.

That will be especially important should these workers lose their jobs or prescription drug coverage — and realize they can pay up to 80 percent less on their medications by ordering through’s network of licensed mail-order pharmacies.

All that being said, we continue to find the arrogance and hypocrisy of the big health insurance companies astounding.

About Cary Byrd

eDrugSearch founder, Cary Byrd, has been called an “e-health innovator” by MarketIntellNow, interviewed by top pharmaceutical industry journalists, invited to Matthew Holt’s Health 2.0 Conference and a Consumer Report's health summit, and highlighted on numerous health blogs. - Search. Compare. Save.

0 thoughts on “Are mail-order prescriptions needed for employer-based health plans?

  • My insurance company will save less than $10 on a drug that costs about $1600 per month. It must be refrigerated and I’m not home. No problem, they say, we’ll mail it TO YOUR WORK! How is this allowed under HIPPA?

  • Surely you realize the hypocrisy in Nease’s statement!!!
    If the 90-day option is so great, how come EXPRXS PROHIBITS its memberpharmacies from offering it??

    Jesus, you’re so close to the issue; but, as a selfproclaimed fan of mail-order mills, you’re still missing it.


  • If anyone who is a so called “fan” of mail order calls a local pharmacy and asks for advice or information about a medication because EXP SCRPTS put you on hold for an hour or wants a hand out because UPS lost the medication that keeps you from having a heart attack I hope the pharmacist dismisses you and that you are forced to deal with the not so pretty side of your “cheaper” pharmacy.

    These PBMs are the largest middle-man scam that the nation has ever seen and nobody realizes it

    exp scps is not a necessary entity at all. They blackmail the drug co. with promises of giving their medication preferred status, blackmail the Ins co. with promises of increased revenue, blackmail the employer with promises of decreased cost, and they blackmail the beneficiary with promises of excellent service.

    If they did not exist at all then everyone would be better off on the whole.

  • Blue Shield has required me to have 2 PBM’s.Or pay $5.00 more to pick up at the pharmacy. I call in Multiple Medicines different days of the month. If they send two. it is of no advantage, and like the article said, “where is the freedom of choice” I am retired, and can not afford $10.00 more a month for greed. so I did a foolish thing, I quit taking the meds..I (we) have a awful habit of wanting to eat..

  • The sad part is people think they are saving money through mail order but the reality is someone is still paying for it. Mail order services rip off employers that front the bill. They repackage their own NDC and mark it way up ex: 1000% then say… hey we will give you half off drugs… well how about you just charge us the fair market price and everyone from the employer to the patients will pay less!! Look at PBM’s stock prices! Look at their yearly returns and how much money they are making!! Its sad how badly PBM’s are ripping customers off. Want to lower the health care for America? Get people’s greedy hands out of the cookie jar and help America.

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