BACKGROUND: This qualitative study aims to assess perspectives of clinicians and clinic staff on mail-order pharmacy dispensing for medication abortion.
METHODS: Participants included clinicians and staff involved in implementing a mail-order dispensing model for medication abortion at eleven clinics in seven states as part of a prospective cohort study, which began in January 2020 (before the FDA removed the in-person dispensing requirement for mifepristone). From June 2021 to July 2022, we invited participants at the participating clinics, including six primary care and five abortion clinics, to complete a semi-structured video interview about their experiences. We then conducted qualitative thematic analysis of interview data, summarizing themes related to perceived benefits and concerns about the mail-order model, perceived patient interest, and potential barriers to larger-scale implementation.
RESULTS: We conducted 24 interviews in total with clinicians (13 physicians and one nurse practitioner) and clinic staff (n = 10). Participants highlighted perceived benefits of the mail-order model, including its potential to expand abortion services into primary care, increase patient autonomy and privacy, and to normalize abortion services. They also highlighted key logistical, clinical, and feasibility concerns about the mail-order model, and specific challenges related to integrating abortion into primary care.
CONCLUSIONS: Clinicians and clinic staff working in primary care and abortion clinics were optimistic that mail-order dispensing of medication abortion can improve the ability of some providers to provide abortion and enable more patients to access services. The feasibility of mail-order pharmacy dispensing of medication abortion following the Supreme Court Dobbs decision is to be determined.
BACKGROUND: Registry: Clinicaltrials.gov.
BACKGROUND: NCT03913104. Date of registration: first submitted on April 3, 2019 and first posted on April 12, 2019.

CONCLUSIONS: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
OBJECTIVE: The establishment of a new outpatient pharmacy provided a strategic opportunity to repurpose and convert an existing outpatient pharmacy into a closed-door mail-order pharmacy within a health system. This article describes the steps taken to successfully make this change and evaluates the impact.
CONCLUSIONS: The mail-order pharmacy conversion project was divided into 3 phases: phase 1 (before conversion) from July through August 2022, phase 2 (conversion) from October through November 2022, and phase 3 (after conversion) from December 2022 through February 2023. Phase 1 included standardizing workflows with standard operating procedure (SOP) development, improving automation, determining staffing ratios, gathering baseline staff engagement data, and identifying primary and secondary outcomes of interest. Phase 2 encompassed SOP implementation and training of mail-order team members. Phase 3 involved evaluating available pharmacy floorspace, marketing mail-order services, and the second distribution of the staff engagement survey. The measured outcomes of this project were total prescription volumes, increase in total revenue, and staff engagement. Data collection was completed in phase 3.
CONCLUSIONS: The existing outpatient pharmacy was successfully converted to a closed-door pharmacy, and the associated prescription volume increased. Developing a strategic action plan to establish SOPs, calculate staffing performance metrics, and identify opportunities for growth and engaging frontline team members were essential to the success of this project.

Background. Direct-to-consumer sale of prescription medications by pharmaceutical companies has emerged as a novel delivery method. It is important to ensure that patients who choose this method are receiving adequate pharmaceutical care that meets established practice standards. Objective. The objective of this study was to assess consultation for patients who are receiving medications via direct-to-consumer sales of prescription drugs from pharmaceutical companies. Methods. We conducted a blinded telephone survey using 10 mock prescriptions for simulated patients (secret shoppers) by contacting the 2 companies currently offering prescription medications for sale directly to consumers. Results. Simulated patients in this pilot study only had a pharmacist initiate consultation for 20% of the calls. Multiple pharmacy technicians offered consultation and this behavior does not follow state statutes. In addition, technicians also failed to forward calls to the pharmacist-on-duty, instead suggesting the patients contact their physicians. On a further direct request to speak to a pharmacist, a consultation did occur for 90% of the calls. However, the consultation failed to achieve practice standards set by Omnibus Budget Reconciliation Act of 1990 and the state statutes for the majority of the encounters. Conclusion. These results warrant a larger scale study of consultation for direct-to-consumer prescription sales. In addition, they highlight areas for training needed for all pharmacy personnel who work in this venue.

BACKGROUND: There is a paucity of research on the population characteristics of mail-order pharmacy users.
OBJECTIVE: This study utilized a nationally representative sample to examine the characteristics of mail-order pharmacy users.
METHODS: This study used data from the 2012 Medical Expenditure Panel Survey (MEPS). The outcome variable was defined as whether the participant had used a mail-order pharmacy during the study year. Logistic regression was conducted to determine the factors which influence mail-order pharmacy use. All analyses incorporated MEPS sampling weights to adjust for the complex survey design.
RESULTS: Among the 14,106 adults included, approximately 18% of them had used a mail-order pharmacy at least once to fill their prescription in 2012. Compared to community pharmacy users, mail-order pharmacy users were more likely to be white, older, married, have a higher family income, a higher educational level, have health insurance, and have a prescription with at least a 30-day supply. There is no difference in gender or urban/rural disparity. In addition, mail-order pharmacy users had a lower percentage of out-of-pocket costs.
CONCLUSIONS: Mail-order pharmacy use was significantly associated with certain patient characteristics. Policymakers should consider these characteristics when promoting mail-order pharmacy use.

The VA system is the largest single provider of healthcare in the United States and to individuals infected with HIV specifically. High quality medication management is particularly important since HIV is a chronic infectious condition which requires taking multiple medications with strict requirements for adherence to medication regimens. Veterans Administration (VA) patients are required to obtain all chronic medications using the VA mail-order pharmacy system.
Drawing on Donabedian\'s Quality Improvement framework, this study sought to examine experiences that Veterans with HIV have with the Veterans Administration medication mail-order system, and to explore opportunities for quality improvement.
A sequential, explanatory mixed-methods design was used to interview Veterans receiving care at a Midwestern Veterans Administration Hospital using a mail-order experience survey followed by in-depth interviews. All 57 Veterans, out of 72, who were successfully contacted consented to participate.
Overall, Veterans evaluated the mail-order service positively and valued the accuracy (correct medication delivery). However, a notable problem emerged with respect to assuring access to HIV medications with about half (47%) indicating running out of HIV medication. Respondents identified structural issues with respect to days covered by mailed medications (90 versus current 30 days) and process issues with scheduling new refills. Veterans also indicated the information sheets were too long, complex and not helpful for their queries. Patients were open to pharmacists playing an active role during clinic visits and felt this would help manage their conditions better.
Veterans generally reported that the VA Mail-order service was of high quality. However, some findings indicate there are opportunities to improve this service to be more patient-centered particularly for vulnerable HIV patients.