Customer satisfaction with mail-order pharmacies declined for the second year in a row, according to a new survey from J.D. Power and Associates, and that could spell trouble for health plans that insist on their usage. Those who are required to get their prescription medications by mail order were significantly more likely to give the service a low rating than those who elected the option themselves.

On a 1,000-point scale, J.D. Power says, overall satisfaction with mail-order pharmacies fell to 792 this year, down from 814 in 2011. Satisfaction with brick-and-mortar pharmacies took only a minor hit, from 818 down to 814 in 2012. Categories such as cost, service and process were used to evaluate approval.

“The erosion in customer satisfaction with mail-order pharmacies may foretell challenges to their business model, as prior to 2011 customer satisfaction was more equivalent to the brick-and-mortar experience,” says Rick Millard, senior director of the health care practice at J.D. Power. “Acceptance of mail-order programs grew by offering customers convenience and lower costs. While this has been a successful approach, the mail-order business needs to continue to adapt to meet customers’ increasing expectations.”

The survey reported only a nominal bump in the proportion of customers who say they are required to use mail ordering (42% instead of 2011’s 41%), but those who do so willingly give the largely web-based service an 810. Those for whom it is mandatory: 768. And in terms of cost-competitiveness, the same groups give mail-order a 773 and 714, respectively.

“Customers who are given a choice tend to perceive they are paying less than they would at a store pharmacy, or are deriving a better value for their purchase,” says Millard.

Asked in an interview if declining satisfaction would just be a lump that people would have to take as businesses moved online, Millard compared pharmacies to booksellers – shops persist even as Amazon thrives.

“What’s so interesting about this sector is we have these two business models, both of which can be satisfying, but for completely different reasons,” he said. “And it seems to me that there’s a segment of customers who would prefer to sacrifice the convenience that mail-order provides in order to have that face-to-face encounter and the store experience.”

Health plans that insist on mail-order drugs run the risk of incurring the wrath of participants, Millard says, if they don’t keep that service shipshape.

“I think that that could be an incipient problem for health plans if they don’t address it, because satisfaction with health plans tends to be low as it is,” Millard comments. “But what’s going to be key is what sort of mail-order experience they’re delivering. If it were possible for customer ratings of mail-order to be as enthusiastic as best-in-class online retailers, then one might conclude that health plans would be able to establish requirements for mail-order with less penalty.

“Consider the importance of customer choice. … Members of health plans tend to have higher levels of satisfaction if they were able to select their health plan, ideally, or at least selecting their coverage.”

As for those whose plans still include physical pharmacies, Millard recommends they take advantage of one of their most central assets: the pharmacist.

“Pharmacists, who are viewed as one of the most highly esteemed professional groups, are there to provide customer service, not just dispense prescriptions,” Millard says. “It’s surprising that more customers don’t utilize the opportunity, given that pharmacists provide free health advice, and you don’t have to make an appointment."

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