Mail Order Pharmacy is Booming – Here’s What to Look Out For


Editor’s Note: People who take insulin require consistently affordable and predictable sources of insulin at all times. If you or a loved one are struggling to afford or access insulin, click here.

This article was last updated Thursday, Jan. 20, 2022.

COVID-19 has prompted many people with chronic illness to consider getting prescription drugs delivered through mail order pharmacies so they don’t have to deal with the risk of in-pharmacy visits. While a variety of options had already been available, the addition of Amazon’s mail order pharmacy in November 2020 broadened the options for people looking at mail order as a possibility. The launch of Mark Cuban Cost Plus Drug Company sought to further that mission with its market debut in January 2022.

Particularly for anyone reliant on insulin, receiving medication through the mail can come with risks and the cost-savings often touted by mail order pharmacies may not always apply. Below, we explore how Amazon’s launch may impact the industry, as well as the overall impacts on cost, access, affordability, and convenience that mail order pharmacies can offer.

Amazon’s Digital Pharmacy

In November 2020, Amazon made a big move into healthcare by launching an online pharmacy. Prime members are eligible to cover their prescription medications with their health insurance, paying a typical copay. If Prime members don’t have health insurance or don’t want to pay for their prescription medication using health insurance, they have access to generic and brand-name medications, some of which are discounted from the typical list price. Amazon offers its customers access to pharmacists 24/7 for consultations, accepts most types of insurance and offers 30-day, 90-day and 6-month supply options.

This Amazon launch comes two years after it acquired PillPack, an online pharmacy known for putting the customer’s prescriptions into one complete packet and delivering it on a monthly basis. By launching its own digital pharmacy in 2020, Amazon has sent shockwaves through the healthcare sector, taking direct aim at its largest competitors, CVS Health and Walgreens, according to Bloomberg. Amazon also aims to compete with Walmart’s pharmacy.

While this launch has undoubtedly caused a stir in the mail order pharmacy market, it begs a bigger question for consumers: “What will the future of mail order pharmacies be?” And, for the diabetes community, “Will mail order pharmacy services offer better savings and convenience for managing my type 1 diabetes?”

The Mark Cuban Cost Plus Drug Company

The Mark Cuban Cost Plus Drug Company, entered the mail order pharmacy market on January 20, 2022, with a goal to be “radically transparent” with its customers about drug pricing. The company buys prescription drugs directly from manufacturers and sells them at a flat 15 percent markup with a $3 pharmacist fee. By cutting out the middleman, they can offer the lowest direct-to-consumer prices on more than 100 medications. They are registered as a pharmaceutical wholesaler. The company offers 90 percent savings on ultra-high-cost drugs by selling them as generic medications and working directly with drug manufacturers. This model improves adherence via increased access and affordability. 

Savings vary by medication. For people with diabetes, for example, you can save as much as $16.40 on metformin. The listing price is $3.60 compared to the average retail price of $20. Glipizide Extended-Release (ER) (Generic for Glucotrol XL) slashes typical retail prices in half, listing the medication at $6.23 instead of a $12.83 retail markup. Other diabetes drugs savings listed include glimepiride (Generic for Amaryl), glipizide (Generic for Glucotrol), and metformin Extended-Release (ER) (Generic for Glucophage XR). Prices and savings listed have been calculated based on a 30-day supply of the lowest strength, so depending on your needs, you may find that the final cost differs once your prescription is filled.

Medications for various conditions from diabetes to allergies to high blood pressure to hormone therapy and beyond are offered. Healthcare providers can fulfill prescriptions online or via phone, fax, or mail. Delivery is available in all 50 states. To use the company as your pharmacy, talk to your healthcare provider about getting started. It is yet to be seen whether the company will expand into other medications beyond tablet form, such as insulin.

Impacts on Cost

Depending on the consumer’s health insurance plan, a mail order pharmacy may save time and money. But without insurance, the consumer is unlikely to benefit. Often, through insurance, consumers are given discounts by ordering a 90-day supply (versus 30-day supply) through their health insurance’s own or contracted mail order pharmacy. Whereas, at a local in-person pharmacy, it may cost the consumer more to get the same refill for this select number of days.

The best way to determine if it will save you money by ordering from your local pharmacy versus ordering through your insurance’s mail order pharmacy is by calling both pharmacies to run a cost estimate before you fulfill your prescriptions. Or, if you have the option, you are often able to run a cost-savings analysis through your insurance website, usually found under “Pharmacy Benefits.”

Mail order pharmacies may make it more difficult to submit coupons through manufacturer programs or from GoodRX discounts, among others. Whereas, speaking to a local pharmacy rep may make the process easier and ensure you get the best prices on your medications. Combining coupon programs with insurance can be tricky, often leaving the consumer to weigh which option may provide a larger discount or benefit.

Impacts on Affordability

While mail order pharmacies do offer discounts to consumers through various coupon or 90-day ordering programs, many of these discounts still do not bring the price of insulin down to an accessible and affordable place for the general population. While advocates across the United States have petitioned to have insulin prices capped at $100 or less for a month’s supply, many discount programs offered through mail order pharmacies still cost the consumer hundreds, and sometimes even thousands of dollars, for 30, 60, or 90-day supplies.

The cost of insulin depends on the consumer’s access to robust health insurance coverage or eligibility for patient assistance programs or manufacturer coupons. Unfortunately, despite marketing claims from companies like Amazon, there is no clear sign that mail order pharmacies have or will help progress the access to affordable care. Pricing on the medication still comes down to who the product is made by, not who the product is sold directly to the consumer by, particularly as insulin remains one of the most expensive liquids in the world.

For blood glucose monitors and test strips, cost-savings often lie in ordering generic or subscription versus name-brand. Some generic or subscription test strip services offer a blood glucose meter for just $10-50, then a monthly supply of test strips for $8-$50 without insurance. Whereas, with insurance at their local pharmacy, consumers may actually pay more for the name-brand meter and strips because insurance dictates which meter and strips are preferred under their formulary.

Impacts on Convenience

Mail order pharmacies have been shown to save consumers time. Digital prescription management and automatic refill opt-ins make the reorder process much more efficient and accurate. Consumers are able to easily manage their prescriptions on desktop and mobile devices for many mail order pharmacies today. However, if your prescriptions are set to run at a certain time, it may be difficult to disrupt the cycle if you won’t be home, whether because of work, vacation, visiting friends and family, etc. There is also the risk of medications being left outside your door for too long or even being taken if you live in a place that is generally unsafe for receiving high-cost packages.

For people with type 1 diabetes, you may also be concerned over insulin being kept cool until you’re able to get home and move your supplies to the fridge until you’re ready to use them. Mail order pharmacies generally include cooling packs when sending insulin. Additionally, if you need to start a prescription medication ASAP that’s new, a mail order pharmacy won’t be the best option. You may opt to enroll repeat medications with your mail order pharmacy but enroll new medications with a local pharmacy in the interim.

As mentioned above, mail order pharmacies are also limited in terms of face-to-face interactions, but you are often able to call your mail order pharmacy to ask questions or address concerns. If talking to a person face-to-face is a dealbreaker for you, mail order won’t be the most valuable option. You may also run the risk of medications arriving late or damaged through mail order pharmacies.

Overall, while mail order pharmacy makes sense for a lot of Americans, especially in today’s pandemic world, it may not be the safest, most cost effective, or most valuable option for people with type 1 diabetes. In order to find out if it’s the best method for you, talk to your healthcare team and do your research. Especially when it comes to insulin, getting your medications on time and intact is something you can’t gamble on.

WRITTEN BY Julia Flaherty, POSTED 12/04/20, UPDATED 05/14/22

Julia Flaherty is a published children’s book author, writer and editor, award-winning digital marketer, content creator and type 1 diabetes advocate. Find Julia’s first book, “Rosie Becomes a Warrior.” Julia finds therapy in building connections within the type 1 diabetes community. Being able to contribute to its progress brings her joy. She loves connecting with the diabetes communities, being creative and storytelling. You will find Julia hiking, traveling, working on her next book, or diving into a new art project in her free time. Connect with Julia on LinkedIn or Twitter.