Jan Stowe saw countless patients go through withdrawals during her 40-year nursing career, but last month she experienced it herself when the U.S. Postal Service failed to deliver her medication for chronic back pain and muscle spasms.
A nurse for combat veterans during and after the Vietnam War, Stowe said she could identify her own symptoms but couldn’t do anything but wait in her Traverse City, Michigan, home.
“I was jittery. I was anxious. I wasn't able to concentrate. I was pacing. I was feeling nauseous. I was sweating. It was all the symptoms,” Stowe said of last month's experience. “I mean, I've never taken heroin, but I've taken care of drug addicts. Now I know what it feels like.”
Stowe, whose back problems forced her into retirement, is among thousands of Americans who have missed their prescription medications because of Postal Service delays. A dramatic decrease in on-time deliveries since the beginning of July has put lives in jeopardy as a growing number of people depend on getting their prescriptions by mail.
The Postal Service manages 1.2 billion prescription drug shipments a year — or about 4 million each day, six days a week — the National Association of Letter Carriers reported earlier this year. That number has grown during the pandemic, and many recipients are accusing President Donald Trump and the White House of orchestrating mail delays to undermine mail-in voting. Postmaster General Louis DeJoy said last week that he would suspend any operational changes to the Postal Service until after the election to avoid any impact on voting by mail. But that doesn't address secondary effects, such as delayed prescriptions and the economic fallout on small businesses.
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Erin Fox, a pharmacotherapy professor at the University of Utah, emphasized that most prescriptions fulfilled through the mail treat chronic conditions, rather than short-term prescriptions, like a course of antibiotics.
She said these medications often treat cholesterol or high blood pressure — and without them, patients could have heart attacks or strokes — but also consist of inhalers, insulin and anti-rejection medicines for people who have had organ transplants.
“Delays with the postal system is very concerning because patients may not be able to access the chronic medications that they need,” she said.
For Ray Carolin, an Air Force veteran and former Secret Service agent who lives in Lafayette, Indiana, delayed medications can be the difference between life and death. When the Postal Service doesn’t deliver the medications sent by the Veterans Administration, which fulfills 80 percent of its prescriptions by mail, Carolin is left scrambling to find the drugs he needs and forced to pay out of pocket.
“Those drugs are pretty important to me — they keep me alive,” Carolin said. “And on one occasion I had to drive 60 miles to go over to the VA hospital in Indy because I hadn't received some heart medicine. And on another drug that I had to have, I had to go to CVS Pharmacy locally here in Lafayette as opposed to driving over to Indianapolis, and I had to go buy my medicine because I didn't get it from VA.”
Sens. Bob Casey and Elizabeth Warren, of Pennsylvania and Massachusetts, respectively, are attempting to bear down on the issue by reaching out to the companies that actually fulfill the prescriptions.
The two Senate Democrats sent a series of letters to the top five mail-order pharmacies and pharmacy benefit managers — including Cigna's service, CVS and Walgreens — about the delivery delays of prescription drugs sent to older people, veterans and millions of other Americans, who, they wrote, face “grave risks if President Trump's efforts to degrade the mail service results in delays and disruptions.”
Casey told NBC News that he had received more than 97,000 letters from constituents about the policies instituted by DeJoy, a longtime Republican ally and former logistics executive who admitted during a congressional hearing Friday that his changes had caused some of the delays.
Sen. Rob Portman, R-Ohio, pressed DeJoy about prescription drugs on Friday, telling him of the "heartbreaking stories" he's heard, sharing the anecdote of a veteran with chronic obstructive pulmonary disease who reached out to his office after enduring a long wait to receive his inhaler.
“We are working here feverishly to get the system running, add stability and also to hire more workers to handle the delivery process," DeJoy said. "We all feel bad about the dip in our service level."
Constituents from all 67 of Pennsylvania’s counties have reached out to Casey’s office, from “veterans missing medications in Clarion County to small-business owners in Wexford who depend on reliable postal service to deliver their products to their customers,” Casey said.
“I’ve heard from young families with immunocompromised children waiting for days for mail to refill their empty prescriptions in the suburbs of our major metro areas,” the senator added. “The Trump administration’s sabotage at the USPS is felt across Pennsylvania, but we know that it is particularly harmful to rural communities.”
What many may not realize is that the insurance industry has forced or heavily incentivized a lot of prescriptions to be sent via mail, Fox said. All of the major insurance companies have a mail-order system, which tends to be cheaper and easier for patients — especially as they don’t always have to remember to refill their prescriptions themselves.
But if patients run out of medications and try to switch to a local pharmacy, they may run into a number of stumbling blocks.
“In some cases, the insurer just really may not allow it, and then they may charge them a lot more,” Fox said. “Logistically, it's a hassle. They're going to have to make phone calls and try to get things switched, and it's not an easy process to do that.”
It’s also an especially fraught time to be dealing with these issues, as many at-risk Americans with pre-existing conditions have turned to mail delivery for prescriptions because they want to avoid public spaces during the coronavirus pandemic.
Max Cooper, a Pennsylvania doctor who works outside Philadelphia, said he got his in-laws three months' worth of prescriptions when COVID-19 began to sweep across the country because they were vulnerable to the disease. Mail delivery has helped, as well.
But after hearing about these mail delays, Cooper — a veteran of the war in Afghanistan who now works with the Committee to Protect Medicare — said he quickly thought of the people he treated right after they came off the battlefield in Helmand Province, one of the most dangerous regions in Afghanistan, and those he helped in Philadelphia at the VA hospital where he volunteered.
All of them likely depend on the VA for their prescription drugs, and most receive their medications by mail.
“Every single shift that I was there, there was a veteran in some sort of psychiatric crisis where they were struggling because they couldn't get the antidepressants or anti-anxiety medications that they clearly needed to treat their service-related psychiatric disorders,” he said of his time working at the VA hospital. "I saw veterans having strokes, suffering from diabetes and heart issues."
“This is just one more way to prevent these folks from getting the drugs that they so critically need,” Cooper added. "That means more veterans are going to have heart attacks, strokes and die early lives full of unneeded suffering."
Casey said the mail crisis highlights the need for USPS to receive additional funding, though Trump has previously threatened to veto any bill that included dollars earmarked for the federal agency. Nevertheless, Congress continues to debate whether to provide the Postal Service with $25 billion to help it through the pandemic.
The Pennsylvania senator plans to “keep pressing the administration to increase the funding for USPS and reverse the harmful policies that caused the service delays.”
For patients like Stowe, that pressure is necessary to avoid “the misery” she said she experienced, which kept her from being able to turn her head or neck. While her pain medication was life-altering, she said, there are many others who need their medications to survive.
“We've just got to get the Postal Service funded because so many people do rely on it for their medication,” Stowe said. “Without it, people are going to die.”