Resolution: F-20-8: FUNDING CUTS AND OPERATIONAL CHANGES TO THE UNITED STATES POSTAL SERVICE JEOPARDIZE PUBLIC HEALTH DURING THE COVID-19 PANDEMIC AND BEYOND

[Valerie Lile]

1  WHEREAS, The United States Postal Service (USPS) is a critical public service that is used for
2  the adequate, timely delivery of essential mail and parcels, such as prescription medications and
3  home health devices.
4  WHEREAS, the USPS handles 1.2 billion prescription drug shipments per year, and delivers
5  hundreds of millions of lab tests and medical supply shipments.¹
6  WHEREAS, recent policy changes, including cuts to postal worker overtime and requirements
7  that trucks leave at the scheduled time even if the truck is not yet fully loaded, have led to the
8  delayed delivery of life-saving medications.²
9  WHEREAS, such policy changes have been enacted with the intent to cut costs, but have led to
10  widespread delays in the delivery of medications, and similar future policy changes could be
11  expected to have similar effects.²
12  WHEREAS, a staff report conducted by U.S. Senator Elizabeth Warren and U.S. Senator Bob
13  Casey detailed findings from five of the largest pharmacies and pharmacy benefit managers that
14  suggested there has been a 20% increase in prescription drugs filled through mail-service
15  pharmacies during the COVID-19 pandemic.³
16  WHEREAS, the report further indicates that the mail-order pharmacies that are heavily reliant
17  on USPS for delivery of mail-order drugs reported an increase in average delivery times ranging
18  from 18-32%.³
19  WHEREAS, delays in mail service are also imposing a financial burden on mail-order pharmacy
20  companies with a reported 35% increase in the number of reshipments.³
21  WHEREAS, the U.S. Department of Veterans Affairs’s (VA) Consolidated Mail Outpatient
22  Pharmacy system (CMOP) offers about 120 million prescriptions annually. The VA sends 80%
23  of all prescription drugs through this program to approximately 330,000 veterans.⁵
24  WHEREAS, the USPS is the primary delivery system utilized by CMOP, and typically
25  prescriptions arrive within 3-5 days as reported by the VA, but in the wake of aforementioned
26  recent policy changes, Veterans and VA employees have reported experiencing wait times for
27  mail-ordered prescriptions that are double or triple compared to normal.⁶
28  WHEREAS, the National Council on Independent Living and the American Association of
29  People with Disabilities has reported that parents with medically disabled children are concerned
30  about the timely delivery of their children’s medications.⁷
31  WHEREAS, the COVID-19 pandemic has resulted in an increase in individuals utilizing remote
32  2 telehealth services for healthcare needs,
1  WHEREAS, the percentage of Americans who intend to vote by mail during the 2020 general
2  elections has increased compared to previous election years, underscoring the importance of the
3  USPS as a public health asset, especially during a pandemic.^8,9
4  WHEREAS, over 50% of those who utilize mail delivery service for medications are over the
5  age of 65 and over 54% of this group are prescribed at least four different types of
6  medications.¹⁰
7  WHEREAS, over 52% of US citizens (>171,000,000 individuals) received prescription
8  medications and health devices through mail order delivery systems in 2019.^10,14
9  WHEREAS, the most common prescriptions filled by mail order for Medicare D enrollees and
10  large employer plan enrollees are for the treatment of chronic conditions including hypertension,
11  type 2 diabetes, hypothyroidism, and high cholesterol. Consequently, delays in USPS delivery
12  can result in negative health outcomes due to inability of patients to adhere to their medication
13  regimens.¹¹
14  WHEREAS, reallocation of funds dedicated to the USPS can limit accessibility and
15  affordability for medications and essential healthcare devices especially for residents of rural and
16  underserved communities that may even be excluded from mail services entirely by private
17  companies or charged a disproportionately high rate.
18  WHEREAS, the USPS operates under its Universal Service Obligation (USO), which mandates
19  that the USPS provide mail delivery services to all US residents, regardless of geographic
20  location, for an affordable and uniform price.¹²
21  WHEREAS, handing off medication delivery responsibilities to private companies — which
22  have no USO and resultantly either charge unaffordable rates or do not deliver at all to remote
23  rural areas and economically-struggling urban areas — will further exacerbate already existing
24  healthcare disparities.¹
25  WHEREAS, limiting access to mail-order prescription delivery contradicts policy H613-A19 of
26  the American Osteopathic Association (AOA), which states:
27  “The American Osteopathic Association opposes pharmaceutical programs that require all
28  medications be delivered to the patient’s residence as failing to act in the best interests of the
29  patient; maintenance medication prescriptions should be obtainable by the means preferred by
30  the patient. 2004; reaffirmed 2009; 2014; reaffirmed as amended 2019”,
31  as reducing access to prescription medication delivery fails to act in the best interest of the
32  patient’s autonomy in prescription delivery preference.¹³
33  RESOLVED, that the Student Osteopathic Medical Association (SOMA) oppose current and
34  future funding cuts and operational changes that jeopardize the ability of the USPS to deliver
35  prescription medications, medical devices, and other equipment, or inhibit its role as a public
36  health asset, and be it further
1  RESOLVED, that the American Osteopathic Association (AOA) oppose current and future
2  funding cuts and operational changes that jeopardize the ability of the USPS to deliver
3  prescription medications, medical devices, and other equipment, or inhibit its role as a public
4  health asset.

Explanatory Statement

The USPS serves a vital role in delivering vast quantities of life-saving medications and medical equipment, particularly to society’s most vulnerable members. It has also shown its utility in keeping Americans safe by supporting our ability to social distance and participate in our democracy during a pandemic. We oppose any funding cuts and operational changes to the USPS that deter our public health infrastructure and put the health and well-being of Americans in jeopardy.

References

1. Ronaldo, F. (2020, March 27). Statement by NALC President Fredric Rolando: The Postal Service is vital in this crisis. Retrieved September 27, 2020 from https://www.nalc.org/news/nalc-updates/statement-by-nalc-president-fredric-rolando-the-postal-service-is-vital-in-this-crisis
2. Side Effects Media (2020, August 25). Postal Service Slowdowns Cause Dangerous Delays In Medication Delivery. Retrieved September 27, 2020 from https://www.npr.org/sections/health-shots/2020/08/25/905666119/postal-service- slowdowns-cause-dangerous-delays-in-medication-delivery
3. (2020). Rapidly Increasing Postal Service Delivery Delays for Mail-Order Prescription Drugs Pose Health Risks for Millions of Americans (Rep.). Washington, D.C.: US Senate
4. National Community Pharmacists Association. (2013, June 25). Medication Adherence in America: A National Report Card. Retrieved September 27, 2020, from http://www.ncpa.co/adherence/AdherenceReportCard_Full.pdf
5. S. Department of Veteran Affairs. (2013, December 17). VA Mail Order Pharmacy. Retrieved September 28, 2020, from https://www.pbm.va.gov/PBM/CMOP/VA_Mail_Order_Pharmacy.asp
6. Defazio, P. A., Takano, M., Fitzpatrick, B., Adams, A.S. (2020, August 14). Congressional Letter – reported delays in Veteran Rx USPS. Retrieved September 27, 2020 from https://defazio.house.gov/sites/defazio.house.gov/files/Congressional%20Letter%20-%20reported%20delays%20in%20Veteran%20Rx%20USPS.pdf
7. Town, M., & Buckland, K. (2020, August 23). RE: People with Disabilities are Impacted by Disruptions to the US Postal Service [Letter to The Honorable Nancy Pelosi, The Honorable Kevin McCarthy, The Honorable Carolyn Maloney, The Honorable James Corner]. https://www.aacom/wp-content/uploads/2020/08/AAPD-NCIL-USPS-Letter-to-House-with-Enclosure-pdf.
8. USAFacts.org. (2020, September 23). By-mail voting: How common was it before COVID-19 and which states will allow it in 2020? Retrieved September 28, 2020, from https://usafacts.org/articles/voting-by-mail-and-covid-19/

9. Wronski, L. (2020). NBC News: SurveyMonkey poll: Voting by mail remains divisive. Retrieved September 28, 2020, from https://www.surveymonkey.com/curiosity/nbc-poll-covid-aug30/
10. Cooper, M. (2020, August 24). Trump’s war on the Postal Service endangers hundreds of thousands of Americans who get medication by mail: Opinion. Retrieved September 27, 2020, from https://www.inquirer.com/news/mail-postal-service-trump-louis-dejoy-prescriptions-medication-20200824.html
11. Juliette Cubanski 2020, A. (2020, August 20). Mail Delays Could Affect Mail-Order Prescriptions for Millions of Medicare Part D and Large Employer Plan Enrollees. Retrieved September 28, 2020, from https://www.kff.org/coronavirus-covid-19/issue-brief/mail-delays-could-affect-mail-order-prescriptions-for-millions-of-medicare-part-d-and-large-employer-plan-enrollees/
12. USPS (2008, October). Report on Universal Postal Service and the Postal Monopoly. Retrieved September 27, 2020 from https://about.usps.com/postal-act-2006/universal-postal-service.htm
13. American Osteopathic Association. (2019). H613-A/19 MAIL ORDER PHARMACY. Retrieved September 27, 2020, from http://policysearch.wpengine.com/wp-content/uploads/H613-A19-Mail-Order-Pharmacy.pdf
14. Kaiser Family Foundation. (2020, March 05). Number of Mail Order Prescription Drugs Per Capita. Retrieved September 27, 2020, from https://www.kff.org/health-costs/state-indicator/number-of-mail-order-prescription-drugs-per-capita/?currentTimeframe=0

Submitted by:

Jerry Ennolikara, OMS II – Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine Ft. Lauderdale
Chris Manikkuttiyil, OMS II – Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine Ft. Lauderdale
Philip Ragusa, OMS II – Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine Ft. Lauderdale

Action Taken:
Date:
Effective Time Period: Ongoing

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