WEDNESDAY, Dec. 16, 2020 (HealthDay)-- Delayed mail delivery due to a push from the White House and others to slash spending and services could have enormous consequences for Americans who depend on the U.S. Postal Service for access to urgently needed prescription medications, a new study warns.
"We found that among those who rely exclusively on mail-order pharmacies, about half are elderly, more than a quarter have heart disease, and about 1 in 5 have diabetes," said lead author Dr. Adam Gaffney. He's a pulmonary and critical care physician with the Cambridge Health Alliance in Massachusetts.
He said many patients who depend on mail-order meds have significant disabilities — 18% have trouble walking a few blocks; 9% have difficulty doing errands alone; and 4% have serious visual impairments.
The upshot: "Millions of Americans -- including those with serious chronic illnesses as well as major disabilities -- rely on the U.S. Postal Service for timely delivery of their vital medications," he said.
The postal service has delivered medications to Americans' doorsteps for more than a century. In 2016, mail-order deliveries accounted for nearly 6% of the roughly 4 billion prescriptions issued.
But the Postal Service has faced financial stress for years. Over the last 11 fiscal years, the postal service has lost about $69 billion, according to the nonpartisan U.S. Government Accountability Office. The shortfall has sparked calls for a major restructuring and funding cuts, especially from the Trump White House.
Against that backdrop, Gaffney and his team set out to paint a pre-pandemic portrait of postal service involvement in medication delivery. They focused on the 2018 prescription orders of a sample pool of about 2,250 patients.
All had filled at least some prescriptions by mail in 2018, with just over a quarter receiving all of their meds by mail.
Over the year, the sample group filled 12,700 mail-order prescriptions.
Researchers said the sample was representative of about 25 million mail-order recipients who filled an estimated 134 million prescriptions in 2018.
Heart drugs accounted for about a quarter of mail-order prescriptions, according to the study.
Other mail-order meds deemed critical — meaning delivery delays could prove hazardous -- included clotting meds (3% of mail orders); cancer drugs (just under 1%); and respiratory meds (more than 4%).
For many, the health issues were serious.
While the study did not explore exactly how delivery delays might undermine the health of mail-order drug recipients, Gaffney said findings suggest that mail delays are not merely inconvenient.
"They could be medically dangerous," he said.
More than 56% of mail-order customers had high blood pressure, and nearly 29% had heart disease.
More than a fifth said they had trouble walking three blocks, and about 1 in 10 had problems running errands by themselves. Nearly 4% said they had eye problems, and about 5% had trouble bathing or getting dressed.
Extrapolating nationally, researchers estimated that about 1 million mail order prescriptions were for the blood thinner warfarin and the anti-clotting drug clopidogrel. About 800,000 were for contraceptives.
And those numbers were before the coronavirus pandemic ushered in lockdowns and other protective measures that appear to be boosting use of mail-order pharmacies.
"A well-functioning, adequately funded postal service is a public health necessity," Gaffney said.
Julie Schmittdiel, a research scientist with Kaiser Permanente Northern California's Division of Research in Oakland, agreed.
"There are many advantages to filling prescriptions by mail, including greater access and convenience, with no transportation or parking barriers to address," she noted. "Many Americans also have prescription benefit plans that make prescriptions less expensive when delivered by mail."
But Schmittdiel said her own research suggests that despite such advantages patient concerns about delivery times are a significant barrier to use of mail order pharmacies.
"Downsizing and slowing of USPS operations will likely only add to those concerns," she said.
She said the new study is drawing attention to an important potential health issue.
"With so many Americans relying on timely delivery of medications, slower wait times may have a real impact on their health and health outcomes," she said.
The findings were published online Dec. 14 in the journal JAMA Internal Medicine.
There's more about prescription drugs at Georgetown University Health Policy Institute.
SOURCES: Adam Gaffney, MD, MPH, instructor, Harvard Medical School, Boston, and physician, Pulmonary and Critical Care Medicine, Cambridge (Mass.) Health Alliance; Julie Schmittdiel, PhD, research scientist, Kaiser Permanente Northern California, Oakland; JAMA Internal Medicine online, Dec. 14, 2020