Brandis Neal, employee of the United States Postal Service (USPS), delivers an Amazon Prime package in Houston, Texas, USA on August 18, 2020.
Adrees Latif | Reuters
Nathan Geissel, who lives in rural Oregon, has waited more than nine days for a life-saving drug to arrive in the mail. As far as he knows, it's stuck in a fulfillment center.
Geissel's doctor prescribed the drug two years ago to prevent blood clots. He's never seen any delays.
The U.S. Postal Service has become a political battleground after President Trump said he was turning down additional funding for not supporting universal mail-in voting. Postmaster General Louis DeJoy, a Trump supporter, reportedly recently ordered cost-cutting measures to reduce overtime and curb late deliveries. This has caused significant delays in mail delivery, according to proponents from postal workers and others.
Americans share stories of medication delays using the hashtag #USPSMeds. Many are veterans who have reported weeks of delays. Some are seniors who have to go to a pharmacy instead, which puts them at a higher risk of exposure to Covid-19.
Geissel chose to mail order for convenience – the nearest pharmacy is 20 minutes away – and affordability. His insurance company pays a larger portion of the cost of the drug if it is delivered by the U.S. Post. Geissel has to pay $ 135 for a monthly supply if he picks it up at a retail pharmacy instead.
"Fortunately, a local pharmacist approved two more weeks of medication with my health plan that I could collect as an emergency," Geissel said. "I work in healthcare, so I know the system, but I can't imagine what it would be like for an older patient who doesn't have the same access."
"I'm worried," Liz Austin said over the phone. Her mother Barbara has cystic fibrosis, a progressive disease that causes lung infections and reduces her ability to breathe. "Covid-19 is primarily a respiratory disease, so my mother relies on the post to get her prescriptions as safely as possible."
Her medicine was so late that her husband had to risk visiting a pharmacy.
Following lawsuits from more than 20 attorneys general and a call to testify in Congress, DeJoy said Tuesday he was suspending operational changes until after the November election.
Some experts are concerned that the delays will snowball.
"It has an exponential factor," said John McHugh, a former congressman who leads the Package Coalition, an alliance that aims to provide affordable mail delivery services. Members of the Package Coalition are the Express Scripts from Amazon, eBay and Cigna. "As soon as you get back, next you come further back and then further back."
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The pandemic has put a strain on the mail order drug system as more and more people receive prescriptions at home. People with pre-existing medical conditions are at a higher risk of hospitalization if they receive Covid-19.
"The data shows an increase in prescription drugs being dispensed through the post-pharmacy during the pandemic," said a spokesman for PCMA, a national association that represents pharmacy service managers and negotiates prescription drug costs on behalf of insurers.
According to online pharmacy Honeybee Health, around 20% of patients who order delivery through prime mail have experienced delays so far.
"The situation is fluid, but our customer service team shows that a typically large number of patients receive their medication much later than expected – and in some cases not at all. These delays are problematic for everyone but for those who need medication." is to live is especially dangerous, "said Dr. Jessica Nouhavandi, co-founder and lead pharmacist of Honeybee Health, which supplies generics through USPS.
Umar Afridi, founder of TruePill, a company that provides pharmacy services to telemedicine companies, said he "estimates that about 90 percent" of the prescription drugs his company ships through the mail service.
"We're more likely to use UPS and FedEx for time-sensitive and expensive drugs," he said. "USPS is often the lowest cost and it has the greatest reach."
Afridi said he hasn't heard of any delays but knows there are service-level disruptions, including late pickups.
Performance managers in the pharmacy are more optimistic. Express Scripts, a major pharmacy benefit manager, said there had been "no unusual delays". OptumRX (owned by UnitedHealth Group) declined to discuss delays. It said it worked with all major carriers "to ensure that prescriptions for home delivery are delivered on time."
Some doctors are concerned about their low-income and elderly patients. Dr. Lakshman Swamy, a Boston-based pulmonologist and intensive care doctor, says the situation could be catastrophic for asthma patients who depend on Medicaid or have no insurance. These patients may not be able to negotiate emergency care.
Swamy, who also has asthma, said it was common for patients with chronic respiratory disease to rely on mail order drugs. "You can do rescue therapies for a while, but the strong drugs will wear off," he said. "If you don't get the medication you need, you can quickly fall off the cart and be hospitalized."
"Any additional stress will affect patients," he said. "It's inevitable."