US Postal Service Role in Medication Supply Chain Crucial to Keeping Saturday Delivery

One important reason for maintenance of Saturday delivery by the United States Postal Service was the importance of weekend delivery in the supply of medications through mail-order pharmacies.

In early 2013, the United States Postal Service (USPS) was losing more than $40 million of taxpayer money each day. As a result of these losses, Congress proposed a restriction on weekend delivery of first-class mail, including elimination of Saturday delivery. The change to delivery policies would have interrupted more than 150 years of weekend delivery service.¹

Following testimony from a variety of stakeholders, including Carl Janssens, vice president of Logistics and Facility Engineering at CVS Caremark Corporation, Congress ultimately decided not to end Saturday delivery.²

CVS Health operates more than 7400 retail pharmacies around the country, in addition to 31 specialty pharmacy locations, and 12 mail-order specialty pharmacies.²

According to Janssens, the USPS has an important role in ensuring the supply of medications across the country, including specialty medications.²

Since 1985 CVS has maintained a relationship with the USPS for delivery of mail-order medications, including those delivered from specialty pharmacies. According to Janssens, these mail order pharmacies receive over a million prescriptions each week.²

Weekend delivery is a critical service because, “on Saturdays, we receive approximately 100,000 prescriptions,” Janssens stated.

In addition, approximately 1 in 5 packages are delivered on Saturdays via the USPS. In 2012 alone, more than 90% of mail-order prescriptions dispensed through CVS mail-order pharmacies were sent via the USPS at a cost, “significantly lower than other carriers.” The affordability of shipping through the USPS enables patients to access medication at a lower cost.²

In his testimony, Janssens cited an article by Duru and colleagues published in a 2010 edition of the American Journal of Managed Care. In the study, investigators examined adherence patterns among patients receiving medications for diabetes, hypertension, and hyperlipidemia through mail-order pharmacies. In the analysis, the researchers identified a subset of patients in the Kaiser Permanente Northern California diabetes registry who started taking a chronic medication during the first half of 2006, and followed patients’ adherence patterns for these newly initiated chronic maintenance medications over a period of 15 months.^2,3

Using a standard metric for adherence assessment known as the medication possession ratio (MPR), investigators measured the percentage of 13,922 eligible patients who had an MPR of 80% or more. Patients with this high rate of adherence were significantly more likely to subscribe to mail-order pharmacy service. A total of 84.7% of patients using a mail-order pharmacy were adherent to therapy (ie, MPR ≥80%) versus 76.9% of patients obtaining medications from local brick-and-mortar pharmacies (P <.001).³

The important role of medication adherence in promoting health throughout the United States, and the importance of reliable medication delivery through the USPS, underscores the importance of supply chain logistics. Despite losing millions of dollars daily, the USPS ultimately maintained Saturday delivery, in part, due to the crucial role its services play in supplying patients with medication every day.

References:

• Bennett D. The Wire. U.S. Post Office to Eliminate Saturday Deliveries. http://www.thewire.com/national/2013/02/us-post-office-eliminate-saturday-deliveries/61844/. Published February 6, 2014. Accessed December 19, 2014.
• Testimony Of Mr. Carl Janssens Vice President, Logistics and Facility Engineering CVS Caremark Corporation. http://oversight.house.gov/wp-content/uploads/2013/04/Janssens-Testimony.pdf. Accessed December 19, 2014.
• Duru OK, Schmittdiel JA, Dyer WT, et al. Mail-order pharmacy use and adherence to diabetes-related medications. Am J Manag Care. 2010;16(1):33-40.