Online pharmacies shine in the era of COVID-19

Physicians and patients have another health-care partner.

By René Luthe, senior editor

Internet shopping was already a force remaking the U.S. retail landscape before the COVID-related shutdowns, and its impact has only grown stronger since. Most retail sectors have seen a 74% rise in online transaction volumes since March 2019, according to ACI Worldwide, a provider of real-time, electronic payment solutions for banks, merchants and billers.

Now, online specialty pharmacies promise to revolutionize the drug-store industry as well. These new players, such as Avella, Medly and Ahma Rx, aim to go beyond the online ordering that CVS and Walgreens, for example, have offered for years. As New York City-based Ahma explains it on its website (ahmarx.com ): “We don’t just dispense medications. From authorization support to financial assistance to medication therapy management … We’ll be an advocate for everyone involved in a treatment plan, so the focus is always on the care of the patient, not the paperwork.”

SPOTTING A NEED

Medly launched in June 2017 in Brooklyn, N.Y., because “The founders noticed a major gap in how individuals interact with the pharmacy and how ideally it is a major hub between patients, providers, manufacturers and insurance,” says Jitu Patel, head pharmacist and chief compliance officer. “The goal was to create a pharmacy that utilizes technology, has amazing customer service, focuses on patient outcomes and creates a seamless experience for everyone involved.”

Many physicians welcome the new mission. “Typically, you prescribe a medication, but the physician and staff spend 10 minutes trying to figure out which CVS a patient goes to,” says Nathan Radcliffe, MD, a clinical associate professor of ophthalmology at New York Eye and Ear Infirmary and a cataract and glaucoma surgeon at the New York Eye Surgery Center. “This is simple.”

“I was introduced to Medly by a pharmaceutical sales manager as an answer to my frustration with my patients getting converted to generic medications without my knowledge,” says Eric Mann, MD, of Eye Associates of North Jersey, in Dover.

HOW IT WORKS

In Medley’s case, the company offers two ways to send a prescription: Patients can either inform their doctors they would like their medication sent to Medly Pharmacy or use the Medly mobile app to transfer their current prescription; alternately, a paper prescription can be dropped off at a Medly Pharmacy or a photo of the prescription can be uploaded to the Medly app. Once the prescription is entered, Medly offers free same-day delivery. Medications are delivered in tamper-free packaging by the members of the HIPAA-certified delivery team, Mr. Patel explains.

These pharmacies provide another service sure to be appreciated by practices: “Specialty pharmacies undertake the prior authorization (PA) and coupon process themselves and consider it their obligation to get these prescriptions paid for,” Dr. Radcliffe says.

“That really alleviates the burden on my office staff,” Dr. Mann adds.

Unfortunately, access to specialty pharmacies is limited — for now. For example, Medly provides services in New York, New Jersey, and Pennsylvania with more locations planned over the next year. Ahma Rx services are available in New York City, Westchester County, N.Y., and parts of New Jersey. Avella has locations in eight states, but offers to deliver prescriptions in all 50 states.

EXPECT THEM TO GROW

The business model of specialty online pharmacies “entirely depends on MDs preferring it,” Dr. Radcliffe says. Given their undertaking of PAs, manufacturer discount programs and delivery, that preference seems a sure thing. Add in the ongoing COVID-19 factor discouraging trips to brick-and-mortar stores, and the future of these pharmacies seems bright indeed.

Specialty online pharmacies like Medly “want to change it so when I write a prescription for a drop, there’s no worrying that it won’t get covered and hearing a week later that the patient hasn’t gotten their meds, is going blind or has high pressure,” Dr. Radcliffe says. “Medly’s approach is that when it is sent a script, it’s going to get it covered or a representative will be in touch shortly.” OM

Letters to the editor

Dr. Patterson:

Thank you for your As I See It column regarding the AAO’s recent statements (bit.ly/2CkWwFj ). We complain constantly about the overreach of government into medicine, and our societies would do well not to go down that road.

In the AAO’s statement regarding shutdowns due to COVID-19, I found one particular comment to be condescending: “all other factors — business, finance, inconvenience, etc. — are remotely secondary.” Profit is but one aspect of our profession. Putting patient safety above all else is our primary priority, and to assume otherwise is insulting.

I gave up my AMA membership decades ago for the very reasons you stated in your column. We have an AAO because we are all too busy running our practices, taking care of patients and providing jobs to fight the good fight. Putting us in legal crosshairs helps no one. This COVID situation is hugely political and emotionally charged. Let us trust each other as colleagues to act in our patients’ best interests, to be able to discern science from hysteria and act like the professionals we were trained to be.

When the AAO speaks, they should stick to the mission: to assist and support us.
—Kim Wise, MD, Wise Eye Associates, Norman, Okla.

Dr. Patterson:

I practice in an area with similar demographics that you described in your article, with low coronavirus-related infections and deaths. Just in my small practice, I know of two examples of preventable blindness from shingles and proliferative diabetic retinopathy that occurred during the shutdown due to fear of getting emergency services. Our surgery center was closed for 6-8 weeks, causing harm to our owners and employees and inconvenience for our patients. This closure was unnecessary in my estimation. While I realize that there is benefit to hindsight, great caution should be exercised when issuing edicts from above to be applied universally.

As you mentioned, the AAO also called on “domestic law enforcement officials to immediately end the use of rubber bullets to control or disperse crowds of protesters.” Do I want to be represented by (and belong to) a physician organization that tells law enforcement how to do their job? While I agree the AAO should educate about the dangers of rubber-bullet use, the intricacies of policy making regarding rubber bullets and “elective health care” should be relegated to politicians, not the AAO.

The leadership of the AAO should “stick to their knitting” and advocate for physicians and patients. That’s it.
— Carter Gussler, MD, Tri-State Ophthalmology Associates, Ashland, Ky.

Ophthalmology Management:

I read Dr. Williams’ article that treatment of retinal diseases with anti-VEGF agents should be primarily done by retina specialists (bit.ly/3ffQaFI ), and I found it condescending toward comprehensive ophthalmologists.

Dr. Williams states that a comprehensive ophthalmologist would need to understand that anterior segment disease (such as meibomianitis, blepharitis or conjunctivitis) is a contraindication. When did a retina specialist start diagnosing blepharitis?

Dr. Williams states that most residents are trained, but doesn’t assure the reader that they are trained by retina specialists to perform these injections. I would argue the average resident knows more about intravitreal injections and management than they know about any other subject: It was nearly 50% of my education. Does it mean that the retina specialists who graduated before pegaptanib was approved shouldn’t be allowed to do retina injections? What about reading OCTs? Should those who didn’t have that in their training (include many retinologists) immediately cease treating their patients?

Also, Dr. Williams states that comprehensive ophthalmologists should know how to perform a paracentesis. I do these every week for severe glaucoma patients. It is a basic skill that I allowed first-year residents to perform on pseudophakic patients, a procedure that any skilled surgeon should be competent performing.

Every retina specialist I know has no desire to manage glaucoma. Why wouldn’t the comprehensive ophthalmologist, then, be even better suited for doing anti-VEGF intravitreal injections per the logic of the high IOP spikes after injections?

Endophthalmitis is always brought up as a reason why comprehensive ophthalmologists shouldn’t perform intravitreal injections. Should we also stop with Durysta, iStent, cataract surgery, premium lenses and other procedures that have a remote risk of endophthalmitis?

In a time when we are under siege by optometry’s battles to expand into surgery, retina specialists are worried about comprehensive ophthalmologists (trained surgeons) performing a basic intravitreal injection while accurately reading an OCT. What a travesty to cut off the nose to spite the face. We had best be careful with these battles. I recommend worrying more about optometrists performing these in the near future rather than a comprehensive ophthalmologist.

I am disappointed that this article was published without a counterpoint. I have debated many things on stages at the AAO meetings, and I hope I am asked to debate a retina specialist on intravitreal injections in the future.
—Michael Patterson, DO, Eye Centers of Tennessee, Crossville, Tenn.