Delivering and Mailing Prescriptions

As consumers become accustomed to having goods delivered to their home, many community pharmacies are jumping onboard to provide prescription delivery for their patients. Providing a prescription delivery service helps meet a growing demand in the marketplace for easy access and delivery to pretty much everything from groceries, take-out, and household goods, to prescription medications. A prescription delivery service not only helps pharmacies gain new patients, but it can help keep existing patients. Some sources estimate that a prescription delivery service can help increase a pharmacy’s revenue on average by 6% to 8%.

However, with providing a prescription delivery service comes several things to keep in mind, such as how to package drugs, workflow considerations, and regulatory concerns (e.g., state/provincial laws, HIPAA, etc). Pharmacy technicians need to know the ins and outs of the prescription delivery process to ensure patient expectations are met, meds are not compromised in transit, and pharmacy laws are followed.

How are prescriptions delivered to a patient’s home?

There are different methods of prescription delivery, such as via courier service, mail, or drones.

Courier Service: Some pharmacies employ their own delivery drivers who make multiple trips a day to drop off prescriptions at patients’ homes, long-term care facilities, etc. Other pharmacies may contract with a third-party company that specializes in same-day delivery such as Shipt, iOmni, ScriptDrop, Deliv Rx, etc. When prescriptions are delivered via courier, they don’t require extensive packaging since the prescription is going directly from the pharmacy to the patient’s home. Prescriptions can also be delivered the same day they’re ordered, as long as the order is placed by a cut-off time specified by the pharmacy.

Mail: Pharmacies may also get involved in shipping prescriptions through the mail using the United States Postal Service (USPS), Canada Post, UPS, FedEx, etc. Prescriptions that are shipped to a patient’s home will require more packaging, such as using a box with packing material instead of a bag, to protect the integrity of the drug since it will pass multiple hands before getting to the patient. Prescriptions will also typically take longer to get to the patient since they must go through processing and sorting by the package delivery company.

Drones: Some pharmacy chains are starting to deliver a patient’s medications to their home using a drone. A drone is an aerial vehicle that is operated remotely by a user using a GPS tracking system. Packages delivered by drone are slowly lowered using a cable. This is still an up-and-coming method of delivery, but will continue to expand in the future.

What are the advantages of delivering medications to a patient’s home?

As previously mentioned, some pharmacies may see benefits from a prescription delivery service through increased revenues, gaining new patients who wouldn’t otherwise come to the pharmacy location, and improving relationships with existing patients.

In addition, the convenience that is offered by prescription delivery may help to improve adherence. Medication adherence is important for a variety of reasons, the most important being the health of the patient. But it’s also important for pharmacies and payers that are focused on improving Star Ratings and other quality measures around adherence.

Prescription delivery also helps prioritize time spent in the pharmacy. When patients choose to have their prescriptions delivered, this saves time at the pick-up counter. However, it’s still important that patients who have their prescriptions delivered know that the pharmacist is available for counseling, or if applicable per state/provincial laws, are contacted by the pharmacist for required counseling. It’s also important that these patients receive information on the medication being delivered, such as patient education handouts, patient information from the manufacturer, MedGuides, etc.

Keep in mind that prescription delivery isn’t just about convenience. In some cases, patients may depend on prescription home delivery to get needed medications they wouldn’t otherwise be able to get in a timely manner; for example, patients with limited mobility, busy lifestyles, lack of transportation, or patients living in rural locations who don’t have a pharmacy nearby.

How should I package medications for delivery?

In general, medications delivered via courier service should be packaged in a plain, non-transparent bag (such as a brown bag) with just the patient’s name and address on the outside of the bag. It’s important for the outer bag or package to conceal what medication is being delivered from the view of others. Similarly, medications that will be shipped should be placed inside a plain package so that the contents cannot be identified. Shipped medications may also require cushioning or filler material (e.g., bubble wrap, packing peanuts, etc) to prevent damage in transit. Stamp or write “fragile” on the package, to prevent broken tablets or glass vials during transit.

When preparing liquids for delivery, you’ll want to take steps to prevent leakage and spilling. Examples of things you can do to prevent leakage and spills include making sure the lid is sealed tight, placing waterproof tape around the lid, double-bagging the liquid into plastic zipper closure bags (e.g., Ziploc storage bags, etc), using enough filler material to eliminate leftover space and prevent the product from tipping over, and stamping or writing “this side up” and “fragile” on the package to help prevent the liquid from being flipped upside down or mishandled.

If your pharmacy delivers or ships refrigerated meds, you’ll want to make sure they’re packaged to maintain the “cold chain.” Cold chain refers to a system of storing and transporting drugs at the recommended temperatures from the point of manufacture to the point of use. This helps maintain the potency of the drug. If your pharmacy delivers or mails refrigerated meds, it’s very important to follow your pharmacy’s policy for packaging to help ensure the cold chain is maintained. This may include placing items in a plastic bag to prevent condensation, shipping with cooling packs, placing temperature monitoring devices in the package, and using express delivery to avoid shipping delays.

What regulatory issues should I be aware of when sending prescriptions out for delivery?

Double check the address that the prescription is being sent to. If it’s an out-of-state address you’ll want to make sure that you are legally able to deliver or ship the medication. Some states or provinces may not allow meds to be delivered to an out-of-state/province address without applying for a mail order pharmacy license. Also be alert for P.O. Box addresses when sending prescriptions that require a patient’s signature to be captured by the delivery driver. P.O. Boxes are not acceptable addresses in these cases since there will be nobody available to physically receive the package.

Include all paperwork, such as HIPAA privacy notices, MedGuides, patient information sheets, or any state-specific notices. For example, in Texas, prescriptions delivered to a patient’s home must include written information that would otherwise be given orally, along with a specific statement instructing the patient to read the information provided before taking the medication and to call the pharmacy with any questions.

Be aware that the United States Postal Service has regulations regarding mailing controlled substances. Licensed pharmacies may mail prescription controlled substances, as long as they’re labeled per federal and state regulations. As previously mentioned, controlled substance prescriptions must be placed in a plain outer package that is free of markings which could indicate the nature of the contents.

If your pharmacy delivers durable medical equipment (e.g., diabetes testing supplies, nebulizers, etc) that has been billed to Medicare, there are some things to be aware of. For Medicare-billed durable medical equipment delivered via courier service, the delivery date must be used as the date of service on the claim (NOT the pharmacy fill date). The patient or their designee must sign for receipt of the item on the delivery date. For supplies shipped by mail, the shipping date will be the date of service on the claim.

What are some workflow considerations with prescription delivery?

Staying organized with pharmacy workflow will help streamline prescription delivery. Pharmacies that provide prescription delivery should have a process for flagging these prescriptions and making sure they are sorted separately from prescriptions that will be picked up in the pharmacy. Clearly indicating on the will-call bag that the Rx is for delivery, using different colored baskets, and flagging patient profiles are examples of how some pharmacies do this. Make sure to prioritize these prescriptions appropriately and devote a special spot to store Rxs that need to be delivered or mailed.

If there’s specific delivery times or mail order cut-off times, you’ll want to ensure that those times are clearly posted for all to see in the pharmacy. As delivery orders come in, try to ensure they get processed and sent out at the next closest scheduled delivery time. If something has to get sent out later than the patient may be anticipating, be sure to reach out to the patient to reset expectations. Also, let patients know as soon as possible if there are any issues with insurance coverage or if there are problems getting the medication.

For prescriptions that will be mailed to a patient, assign one person each day to handle packaging and labeling for shipping. There should be a specified cut-off time, provided by the package delivery company (e.g., USPS, FedEx, etc), for when packages need to go out for next-day, two-day, etc, shipping times. All packages that need to go out that day should be ready to send by the cut-off time.

For more details on how to incorporate prescription delivery and other services into your pharmacy workflow, check out our technician tutorial, Optimizing Pharmacy Workflow.

What prescription delivery best practices should I follow?

Let patients know upfront if prescriptions which will be delivered to their home will need to be signed for, such as the case with most courier delivery services and some mailed meds, depending on pharmacy policies or local laws. In these cases, someone will need to be home, otherwise the medication cannot be delivered. Also let patients know ahead of time if there is a charge for medication delivery so that they aren’t taken by surprise. Giving patients clear information on what to expect with prescription delivery will help prevent delays, the need to reschedule deliveries, and customer service issues.

If available, sign patients up for text message or email notifications so that they are alerted when their shipped medication has been delivered to their home. If prescriptions shipped by mail will not require a person to receive the package, it’s important for patients to be notified of deliveries. This way they can promptly bring the prescription into a temperature-controlled environment. This is especially important during the winter and summer months when temperature extremes are more likely, and with meds that require refrigeration.

When enrolling a patient in prescription delivery, you’ll want to be sure to confirm their desired mailing address and gather their payment info according to your company policy. Before sending any meds out for delivery, you may want to call the patient to confirm their address and payment info, especially if it is the first time they’re having anything delivered or if it has been a while since they had something delivered. Consider confirming expensive medications with patients as well. For example, your pharmacy may want to set a certain dollar amount to contact the patient for confirmation, such as $50, $100, etc. Watch for prescription refills that jump in price from the previous fill, and confirm that the patient is aware of the price difference before sending. State and provincial laws may vary, but generally, once the prescription leaves the possession of the pharmacy or delivery driver, it cannot be returned to stock. You don’t want to put your pharmacy in a situation where a patient is refunded for an expensive med that cannot be reused.

As with all other prescriptions, be extra sure to avoid HIPAA violations by making sure the delivery package includes medications only for that patient. If the wrong medication gets delivered or shipped to the wrong patient, the convenience of prescription delivery is eliminated since the patient will have to return the package. And the pharmacist will have to follow your pharmacy’s policies and procedures for documenting and reporting the HIPAA violation, which takes time away from other pharmacy operations. Unfortunately, pharmacies have been fined because the wrong patient’s medication was delivered.

Know which medications your pharmacy’s policy does not allow to be delivered or mailed. For example, some pharmacies may choose not to deliver controlled substances (oxycodone [OxyContin (U.S.), OxyNeo (Canada), etc], morphine [Kadian, MS Contin, etc]), refrigerated meds (insulin, etc), or meds that require reconstitution (antibiotic suspensions, etc). Also, your pharmacy may restrict mailing of medications that can’t be shaken. For example, agitating epoetin alfa (Procrit [U.S.], Eprex [Canada]) may cause the drug to foam and ruin it.

If your pharmacy allows patients to add other over-the-counter (OTC) items to their deliveries, have the pharmacist do a check to ensure these items don’t interact with the patient’s prescriptions or medical conditions. For example, ibuprofen (Advil, Motrin, etc) can be a problem for patients taking anticoagulants (warfarin, dabigatran, etc), since both drugs can cause bleeding.

Stay organized with delivery-related documentation. For example, assign one person to be responsible each day for organizing and filing proof of delivery documentation if these aren’t electronically captured. Keep separate files and folders for other documents, such as tracking numbers for shipped prescriptions, delivery confirmations, etc. You’ll want to easily access this information if a patient asks about the status of their mailed prescription.

Project Leader in preparation of this technician tutorial (360180): Flora Harp, PharmD/Assistant Editor

Cite this document as follows: Technician Tutorial, Delivering and Mailing Prescriptions. Pharmacist’s Letter/Pharmacy Technician’s Letter. January 2020.

─Continue for a “cheat sheet” summary about delivering and mailing prescriptions─

“Cheat Sheet” for Delivering and Mailing Prescriptions

What methods are used to deliver a prescription to a patient’s home?

The most common methods are via courier service or shipped by mail. Courier service includes delivery drivers who are employed by the pharmacy or outsourced using a third-party company. Delivery by courier service allows for the prescription to go directly from the pharmacy to the patient’s home. This can be contrasted to shipping medications through the mail (e.g., United States Postal Service, Canada Post, UPS, FedEx, etc). With this method, the prescription passes multiple hands and usually takes longer to get to the patient than with courier service.

What are some of the advantages of prescription delivery?

  • Increased revenue for the pharmacy
  • Attracting new patients
  • Improving relationships with current patients
  • Improved medication adherence
  • Timely access to prescriptions for patients who have difficulty visiting the pharmacy

How should medications be packaged for delivery?

In general, meds should be packaged in a plain outer package that conceals what is inside. Shipped medications may require extra cushioning or filler material to prevent damage in transit. Liquids should be packaged to prevent spills and leaks. This includes placing waterproof tape around the lid, double-bagging the container in plastic zipper closure bags, etc. Refrigerated meds should be packaged to maintain the cold chain, which may include use of cooling packs, temperature monitoring devices, and express shipping. All required paperwork should be included in the package being sent for delivery (HIPAA privacy notices, patient information sheets, MedGuides, state-specific notices, etc).

What best practices should I follow to ensure success of my pharmacy’s prescription delivery service?

  • Let patients know if and when delivered prescriptions will need to be signed for to prevent delays.
  • When available, sign patients up for text message or email notifications to be alerted when shipped meds have been delivered, if signature won’t be required.
  • Know and utilize your pharmacy’s method for flagging and organizing delivery prescriptions.
  • Be aware of which medications your pharmacy policy does not allow to be delivered or mailed.
  • Watch for out-of-state/province or P.O. Box addresses; delivery may not be allowed in some cases.
  • Confirm patients want expensive medications before sending them out for delivery.
  • Perform triple checks to ensure delivery packages include Rxs for the intended patient only.
  • Have the pharmacist check OTC items that have been added to deliveries to ensure there are no drug or medical condition interactions.
  • Ensure delivery orders get processed and sent out at the next closest delivery time.
  • Reset patient expectations if there’s a delivery delay.
  • Assign one person each day to be responsible for packaging and labeling prescriptions that need to be shipped by mail.
  • Stay organized with delivery-related documentation.

[January 2020; 360180]