ALEXANDRIA, Va. — Many patients go without their prescribed medications because of slow or ineffective service by mail-order pharmacies, according to a poll by the National Community Pharmacists Association.

The NCPA study, which surveyed more than 400 patients, found that 48% of respondents who were mail-order customers had to go without their medicine because of late delivery. What’s more, patients required by their health plan to use mail order reported much higher rates of late delivery (63%) than those who had a choice of pharmacy (28%).

Patients also reported routinely paying for prescription drugs twice: once for the mail order and another time at a retail pharmacy for an emergency fill when the order did not arrive in time, NCPA said. Nearly every patient (85%) left waiting for their medicine by mail reported having that experience, the survey found.

Patients also expressed frustration with being forced to buy a 90-day supply through mail order only to have the doctor write a new or different prescription later on, leaving them with two months worth of unusable medicine.

NCPA noted that the findings raise key questions about mail-order service, especially two of its purported benefits: added convenience and lower costs.

"These survey results should make employers and other health plan sponsors think twice before imposing a mandatory mail-order requirement on their patients," NCPA executive vice president and chief executive officer Bruce Roberts said in a statement. “Mail-order programs claim to provide patients greater convenience and lower cost. In fact, patients say they have to wait too long for their drugs, and some are paying twice for them.

“Further, mail order is touted as a way to ensure patients stick with their medication therapy," he explained. "But if deliveries arrive too late or are compromised, patient adherence is severely undermined, not encouraged."

To conduct the poll, NCPA  sent an eight-question survey to pharmacies to display on store counters for patients to complete on a voluntary basis. The poll included an option for respondents to submit brief comments, which included the following:

Patient No. 1: "I feel I should have a choice as to where to pick up my meds. Also, my meds change quite frequently, and mail order doesn’t take that into account."

Patient No. 2: "Multiple times during the year, we have not gotten our medications on time. We should not worry when we are going to get our life-saving medications."

Patient No. 3: "The medications that would be mailed must be kept cool. I’m not home often, and it would be a major inconvenience to return home just to get medications from outside into the fridge."

Patient No. 4: "Medicine always seems to be changed from what my doctor wrote."

Patient No. 5: "My brother gets his meds through the mail, and they just leave them outside — do not knock or ring the doorbell. And two times they said they delivered them. We did not get them."

Patient No. 6: “I recently received another patient’s prescriptions, which I do not take. Still haven’t been picked up, but the copay was charged to me."

Because of their experiences, 81% of the NCPA survey respondents said they strongly or somewhat oppose a mandatory mail-order requirement being imposed on health plan participants. NCPA said that sentiment should be addressed in the current health care reform debate, which includes a proposal for a public health plan.

"Clearly, Congress should protect the patient’s ability to choose where to fill prescriptions in any publicly financed health plan," Roberts commented.