Nathan Geissel, who lives in rural Oregon, has been waiting more than nine days for a life-saving medication to arrive in the mail. As far as he knows, it's stuck in a fulfillment center.
Geissel's doctor prescribed the medicine two years ago to prevent blood clots. He's never experienced delays before.
The U.S. Postal Service has become a political battleground after President Trump said he opposes additional funding because he does't support universal mail-in voting. Postmaster General Louis DeJoy, a Trump supporter, reportedly ordered recent cost-cutting measures, slashing overtime and curbing late delivery. It has created significant delays in mail deliveries, according to mail worker advocates and others.
Americans are sharing stories about medication delays with the hashtag #USPSMeds. Many are veterans who have reported weeks-long delays. Some are seniors who instead have to visit a pharmacy, putting them at higher risk of exposure to Covid-19.
Geissel chose mail-order for the convenience — the nearest pharmacy is 20 minutes away — and the affordability. His insurance company covers more of the cost of the medication when it's delivered by the U.S. postal service. Geissel has to pay a $135 copay for a months supply if he instead picks it up at a retail pharmacy.
"Thankfully, a local pharmacist approved two more weeks of medication with my health plan that I could pick up as an emergency," said Geissel. "I work in health care, so I know the system, but I can't imagine what it must be like for an elderly patient who doesn't have that same access."
"I'm worried," said Liz Austin by phone. Her mother, Barbara, is sick with cystic fibrosis, a progressive disease that causes lung infections and limits her ability to breathe. "Covid-19 is primarily a respiratory disease, so my mother relies on the mail to get her prescriptions as safely as possible."
Her medicine was so late that her husband had to risk visiting a pharmacy.
Some experts are concerned that the delays will snowball.
"There's an exponential factor to this," said John McHugh, a former congressman who heads up the Package Coalition, an alliance that aims to preserve affordable postal package delivery services. Members of the Package Coalition include Amazon, eBay, and Cigna's Express Scripts. "Once you are behind, what happens next is you get further behind and then further behind."
The pandemic has strained the mail-order medication system as more people are opt to receive prescriptions at home. Those with pre-existing conditions are at greater risk for hospitalization if they get Covid-19.
"Data show an increase in prescription drugs dispensed through mail-service pharmacy during the pandemic," said a spokesperson from PCMA, a national association representing pharmacy benefits managers, which negotiate prescription drug costs on behalf of insurers.
Online pharmacy Honeybee Health said about 20% of patients who order delivery via first-class mail have experienced delays so far.
"The situation is fluid but it's clear from our customer service team that an usually high number of patients are receiving their medication far later than expected — and in some cases, not receiving it at all. These delays are troubling for everyone, but for patients who rely on medication to live, it's especially dangerous," said Dr. Jessica Nouhavandi, co-founder and lead pharmacist for Honeybee Health, which delivers generic medications via USPS.
Umar Afridi, founder of TruePill, a company that provides pharmacy services to telemedicine companies, said he "estimates that about 90 percent" of prescription drugs his company delivers via mail run through the postal service.
Afridi said he hasn't yet heard about delays but knows there are service-level disruptions, including pickups not happening on time.
Pharmacy benefits managers are more optimistic. Express Scripts, a major pharmacy benefit manager, said it was "not experiencing unusual delays." OptumRX (owned by UnitedHealth Group) declined to discuss delays. It said it's working with all major carriers "to help ensure timely shipments of home delivery prescriptions."
Some doctors are concerned for their low-income and elderly patients. Dr. Lakshman Swamy, a Boston-based pulmonologist and critical care doctor, says the situation could be disastrous for asthma patients who rely on Medicaid or don't have insurance. These patients might not be able to negotiate an emergency supply.
Swamy, who also has asthma, said it's common for patients with chronic respiratory conditions to rely on mail-order medications. "You can do rescue therapies for a while, but the strong medications will wear off," he said. "Once you don't get the medications you need, you can quickly fall off the wagon and end up hospitalized."
"Any additional strain will have an impact on patients," he said. "It's inevitable."