Why Mail Order Loses

By Kyle McCormick, PharmD

What was the initial key to Amazon’s success? I ask this of my rotation students. Nearly everyone responds with convenience, speed, or price. While I don’t disagree that these are strong characteristics that have led to Amazon’s growth, I would argue that their early differentiator was selection. According to some estimates, there have been 129,864,880 books published since the dawn of the press. This volume of literature cannot fit into a single neighborhood storefront. And as a consumer, this selection was appealing — why risk going to a bookstore that may be out of the summer’s hit book or not even carry the obscure sci-fi thriller when you can go to a site and order it with certainty in a few minutes (28k modems, remember?). Early Amazon was pre-prime, pre-2 day shipping, pre-videos and kindle, and pre-lawn chairs and prescriptions; it was just books.

I start with this premise, because I believe this tenet still applies to why people prefer Amazon for many things, but not necessarily for prescriptions. There are more than 350 million products listed across Amazon — after all, it is the everything store. When you are looking for selection, it is one of the most tried and true resources. On the flip-side, there are only 6,800 drugs (and really 1,000 or fewer that make up 95%+ regularly used) in the US. Pharmacies can easily stock or order for next day 100% of a patient’s medication needs in under 250 sq. ft. and within 5 miles of where the patient lives. Therefore, if pharmacies can match the largest mail order’s (/retailer’s) medication selection, what value proposition does mail order have? I would argue that the only tallies in their “pro” column are: convenience (showing up right at the door and/or 90 day supplies) and cost (whether through PBM incentivized copay-structure or free-market solutions like Honeybee Health and Mark Cuban).

But the title argues that mail order loses, and so will I. Local independents were the first to offer delivery, often same-day. This beats out the 5–7 day delivery time that Mark Cuban offers every single time. And on the cost front, community cost-plus pharmacies offer some of the lowest/fairest prices available without playing any inflated U&C games. As more pharmacies adopt fair and transparent pricing, driving down costs in communities across America, we will no longer need to fly 30ct bottles of colchicine from California to Pennsylvania in order to achieve low-cost, convenient care. That future of affordable, convenient pharmacy care is already here in some communities. When we consider the services that community pharmacies offer (POCT, vaccines, etc.), the argument against only strengthens.

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