In this two-part series, we’ll explore what a mail order pharmacy is, why you’d want to use one and how you can get started.
Every day starts out exactly the same for my husband and me: We get up, eat breakfast, take a shower, brush our teeth and take our pills. It’s our routine — it’s something we have been doing every day for years. Except when we don’t.
Sometimes, we reach for the prescription container and notice, “Hey, it’s empty! Looks like today we won’t be taking our medication.” And while it’s no big deal for us to skip a day (our conditions are not, fortunately, life threatening), that’s not the case for everybody — and darting to the pharmacy isn’t always the easiest errand to fit into the daily schedule.
Which is why, when asked to write an article about Highmark’s mail order pharmacy program for health plan members, I perked up. “You mean we might be able to get our prescriptions through the mail?” I asked. “I wonder what the catch is?”
To get the scoop, I sat down with Steve Capuzzi, a pharmacy sales consultant at Highmark (and also a licensed pharmacist), and it turns out there’s no catch! Although mail order is not necessarily designed for urgently needed prescriptions for an acute condition, it’s a great convenience for any kind of maintenance medication — and you can use mail order services for both brand-name and generic drugs.
A mail order pharmacy works similarly to a retail pharmacy (that is, the pharmacy at your neighborhood supermarket, drug store or big-box store). You still hand off your doctor’s prescription to a pharmacist, who checks to ensure that you receive the correct medication in the right dosage, and then get your medication.
To use a mail order pharmacy, Capuzzi explains, “A Highmark health member would either have the prescription sent by the prescriber right from their office, usually electronically or via fax, or they can get a printed prescription and drop it in the mail to the mail order pharmacy.” As he points out, most Highmark members today can have the electronic prescription sent to the pharmacy before they leave the doctor’s office.
After that, Highmark’s mail order prescription partner, Express Scripts (see sidebar), receives the prescription and gets to work. Capuzzi explains, “Once it gets to the mail order facility, it’s entered into the system. Then, there’s the same kind of full drug utilization review that’s performed on it in a retail pharmacy so that the management of the medication can be evaluated on two things.”
The first one is safety. Capuzzi explains that the pharmacist wants to ensure that the most safe and effective medication is getting to you. This safety review includes looking at drug-to-drug interactions (if you’re taking several medications) as well as drug and disease interactions. This step ensures that your prescription won’t cause adverse side effects. Capuzzi states, “It’s about making sure the right patient has the right drug at the right time, taking all things into consideration.”
Next, the pharmacy looks at the dosage of the drug. Typically speaking, manufacturers recommend a specific dosage of the drugs they make, and it’s a pharmacist’s job to make sure the drug isn’t being over-prescribed. Capuzzi says, “In the event there is a drug interaction or that there’s a breach in how much medication has been prescribed — whether it’s a waste or an abuse situation — an outreach would be done to the prescribing medical provider to adjust it for safety and effectiveness.”
After a pharmacist has thoroughly reviewed the prescription, much of the filling process is automated. Express Scripts has a technology that counts out the proper amount of medication and ensures that it’s in the correct bottle with the member’s information, all done in a timely fashion.
After that, it’s sealed in a discreet envelope and mailed right to your door. Standard shipping is free, and this all happens within 7 to 10 days of receiving the prescription.
You’ll still want to plan ahead, though. Because there is a time delay between when you sign up for home delivery and when your first prescription arrives, send in your form well before you need your medication. That helps you to avoid missed doses or lapses in medication.
There are three major benefits to receiving prescriptions through a mail order pharmacy like Express Scripts: longer-lasting refills, cost savings and personalized pharmacy assistance.
A major benefit to Highmark members using a mail order service is that maintenance prescriptions can be filled for 90 days at a time, in most cases. “Many of our clients are used to having only 30 to 60 days filled at retail pharmacies, but with the mail order pharmacy, they’re entitled to a full 90-day supply,” Capuzzi explains.
That means no more last-minute trips to the pharmacy, no more running errands to pick up a medication you take daily, and no more waiting in line for somebody to help you. Your medication shows up at your door, on time, and for three months at a time.
Capuzzi recommends not waiting until you’re down to the last few doses in the medication bottle to order a refill. He suggests that, depending on your benefits, you should aim to reorder when you have used 60 – 70 percent of the medication in your bottle.
That “depending on your benefits” phrase is important. Different plans, and different prescriptions, may vary on when, and how much, you can reorder. If you have any doubt about what’s covered, always call the number on your member ID card for assistance. (We’ll also cover some of these issues in greater detail in Part II of this article.)
Let’s say you’re paying a $20 copay for a 30-day prescription — of a drug you take all the time — under your Highmark prescription plan. Every month, you visit the retail pharmacy, stand in line and pay $20 to get a month’s worth of medication. Twelve months of refills with that copay means you’ll spend $240.
With mail order prescriptions, you could receive that same prescription in a 90-day quantity — and your total copay for the year could be much less. For example, your 90-day copay may be $40, but since you pay that just four times in a year, you only spend $160 total — saving $80 compared to the copay on monthly refills. Capuzzi explains, “If a person is eligible for a greater than 30-day supply at retail, it would be two to three times more expensive at a retail pharmacy.”
Why is it so much less expensive to use a mail order pharmacy? It’s all about volume! Just as you can get lower prices at large chain stores or online retailers like Amazon, a mail order pharmacy fills many more prescriptions than a retail pharmacy. That means they can leverage their size to ensure that people who use their services get the highest possible cost savings.
Prescription medications can come with a lot of questions. When should you take a medication? What are the side effects? Do you need to eat when you take it, or should you not eat at all?
Getting these answers at a retail pharmacy can be challenging — retail pharmacists do so much more than answer questions. They also deal with drive-through customers, answer the phones and work with pharmacy technicians in the store.
Capuzzi points out that many folks who are new to a mail order program are afraid they will lose one-on-one access to pharmacists. “Members say, ‘This comes from the warehouse, this comes from the mail, so I can’t have the personal contact.’ But no, you do! You have a pharmacist; you have somebody who can answer the phone.”
He also points out that a mail order pharmacy may actually give you greater access to a pharmacist than at a retail pharmacy. For example, Highmark members can call a pharmacist at Express Scripts and talk to them, in the privacy of their own home, for as long as they need — 24 hours a day, 7 days a week. You can get answers to any questions you may have about how to take your prescription and its interactions and side effects.
Express Scripts offers fast, friendly advice from pharmacists. You can call the Express Scripts phone number on your Highmark member ID card to talk to a pharmacist, or email an Express Scripts representative with questions about your medication or your billing. And as Capuzzi points out, “In my opinion, it’s easier to interact with an Express Scripts pharmacist than with a retail pharmacist.”
Whether you want more personalized service or you simply want to save money on prescription medications, getting your medications through Highmark’s mail order pharmacy option offers many benefits for members. Ready to get started? In Part II of this article, we’ll explore the steps Highmark health plan members can take to start using Express Scripts.
If you have a member service question that involves personal health or insurance information, do not use the "comments" feature; please call the number on the back of your Member ID card.