Mailboxes at a U.S. Post Office location in Baltimore, MD. August 19, 2020.
As direct-to-consumer pharmacies proliferate, the U.S. Postal Service is vital to timely distribution. This is especially true in remote areas where other delivery options may be limited, and mail-order pharmacy use increases roughly 20% for every 10 miles farther a patient is from a pharmacy.
“The postal network is not simply a logistics backbone -- it is an essential component of the nation’s medication-delivery system,” according to a new Brookings report. “Mail-order pharmacies fill gaps left by retail closures, and they serve as a delivery channel with demonstrated long-run health benefits.”
Through longer refill intervals, automatic delivery and reduced travel barriers, mail-order prescriptions improve adherence to treatment for chronic conditions and reduce avoidable hospitalizations and health care costs. These gains, however, depend on a single, often overlooked assumption that mail arrives reliably, affordably and on time.
The challenge for the USPS is maintaining timely deliveries as it faces severe budget constraints. It developed the Delivering for America plan last year to help modernize service and reduce costs. One element of this plan, Regional Transportation Optimization, consolidates mail processing into regional hubs. However, analysis by groups such as the Postal Regulatory Commission found unevenly distributed delivery slowdowns, especially in rural areas where dependence on mail-order pharmacies is highest.
Although most Americans face at least one form of risk to timely medication delivery, a small subset of communities -- about 6% of the population, or about 3.7 million Medicare enrollees -- depend almost entirely on the postal network for access to prescriptions.
“Because these areas are served by post offices undergoing operational change, even modest delivery slowdowns can have disproportionate effects on medication continuity, with implications for postal policy and the universal service obligation,” the report said.
The geography of the Regional Transportation Optimization rollout suggests that slower and less predictable delivery will be concentrated in areas most dependent on mail services for prescription access. For these communities, even small increases in delivery time can disrupt medication adherence and continuity of care.
“Recognizing mail delivery as both a critical national infrastructure and a proven channel for sustaining long-term health underscores the stakes of postal reform,” the report concluded. “Maintaining the reliability and reach of the mail is not only a matter of efficiency or fairness. It is a condition for maintaining one of the nation’s quietest but most consequential health infrastructures.”
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