Patients with diabetes who use mail order pharmacy are less likely to visit ER's

Patients with diabetes who received prescribed heart medications by mail were less likely to visit the emergency room than those patients who picked up prescriptions in person, according to a new Kaiser Permanente study published in the American Journal of Managed Care.

The study examined 17,217 adult Kaiser Permanente members with diabetes who were first prescribed in 2006 and followed them for 3 years. It found that under age 65 who used mail order pharmacy had significantly fewer for any cause than those who picked up prescriptions (33.8 percent vs. 40.2 percent, respectively).

This study is the first to examine the potential impacts of mail order pharmacy on patient safety and utilization, and explores the concern of patients experiencing adverse outcomes because they do not meet face-to-face with a pharmacist.

"Overall, we didn't see any safety concerns," said Julie A. Schmittdiel, PhD, research scientist with the Kaiser Permanente Division of Research and the study's lead author. "For the vast majority of people, mail order pharmacy works well."

Kaiser Permanente offers members the options of using its mail order pharmacy or picking up at walk-in pharmacies located in Kaiser Permanente hospitals and outpatient medical buildings. Medications can be delivered by mail with free shipping; mail order requests can be made by phone or online; and mail order copayments are often lower for the same supply as walk-in pharmacies.

The study did not look at possible reasons why the use of mail order pharmacies was associated with fewer visits, but researchers noted that further investigation may involve exploring factors such as patients having disabilities, time constraints or limited transportation.

This study is part of Kaiser Permanente's ongoing efforts to understand how mail order pharmacies can improve care. Schmittdiel's previous studies have shown that patients who use mail order pharmacy have significantly better medication adherence and cholesterol management.

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John Norton
Nov 25, 2013
This study should not be applied to the general population. Kaiser Permanente makes up only a small portion of the mail order pharmacy industry and is not representative of the mail order facilities which most people use. In fact, Kaiser Permanente mail order pharmacy is an outlier. Every year it gets far higher customer satisfaction scores compared to other mail order pharmacies in the J.D. Power customer satisfaction survey. The rest of mail order segment receives mediocre reviews at best. Moreover, the J.D. Power and other consumer surveys have documented that patients are more satisfied at community pharmacies.

In addition, a 2013 study reviewing millions of Medicare records concluded that community pharmacies provide 90-day supplies of medication at equal to or lower cost for health insurance plans than mail order and that local pharmacies substitute cost-saving generic drugs more often than mail order.

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