No. 5 — Mail order prescriptions are more expensive. On average, mail order prescriptions are 10 times more costly than a retail pharmacy: $644 for the average mail order prescription compared to $61.51 for the average prescription from a retail pharmacy!

No. 4 — Patient choice? Conflict of Interest? Patients are steered into mail order pharmacies which are owned by or affiliated with PBMs, which are often owned by or affiliated with the health plans hired to provide medical coverage. More than 60 percent of all specialty revenue flows through the control of the big three PBMs/health plans, which is a major driver of the ultra-expensive prescriptions flowing through the mail.

No. 3 — Expensive Waste. Have you visited NCPA's Waste Not, Want Not photo display of mail order medications shipped to patients — whether they wanted them or not — recently? Patients report that they request, beg, even plead, with mail order pharmacies to stop shipping medications that have been discontinued or are even for a deceased loved one, often to no avail.

No. 2 – Retail pharmacists have to clean up mail order's mess. Do any of these scenarios sound familiar at your pharmacy?

Scenario No. 1: "My prescription was supposed to arrive in the mail last Tuesday and it didn't. I've not taken my medication for the last few days waiting for it to arrive. I called the mail order pharmacy and they said they delivered it. They are sending another prescription, but it won't arrive for a few days. What should I do?"

Scenario No. 2: "I got this prescription in the mail. Does it look right to you?"

Scenario No. 3: "I got this liquid prescription in the mail. It's usually clear. This one looks kind of brown to me. Does it look OK to you? Should I still take it?"

Scenario No. 4: "I got this prescription in the mail. I had planned to be home but had to run an errand, so they dropped it off at my neighbor's house. He forgot about it and it sat on his kitchen table for two days. I think it's supposed to be refrigerated. Should I go ahead and use it?"

And, reason No. 1 why mandatory mail order prescriptions are a bad idea: Loss of patient choice. Patients should be able to choose if they want to rely on their mailbox or if they want to receive care from their local pharmacist. The cartoon below is says it all: