The vast majority of Department of Veterans Affairs prescriptions are fulfilled by mail. But as U.S. Postal Service delays mount, more and more veterans are reporting long wait times to receive critical medication and VA staff says the problem is only growing.
In fiscal year 2016, VA's mail-order pharmacy processed nearly 120 million outpatient prescriptions and VA provides about 80% of all its outpatient prescriptions to veterans by mail using seven "highly automated pharmacies," according to the department. The other 20% are filled at local VA medical facilities.
VA's mail-order pharmacy system, the Consolidated Mail Outpatient Pharmacy (CMOP), processes nearly half a million prescriptions daily and each working day, more than 330,000 veterans receive a package of prescriptions in the mail. Veterans who live further from VA medical facilities, especially in rural and remote areas of the country, often depend on mail-order prescriptions.
More than two dozen veterans and more than half a dozen VA employees who work in department pharmacies nationwide reported delays for mail-order prescriptions to Connecting Vets. Those veterans and staff spoke on condition of anonymity because they said they feared retaliation from the department or stigma for the medications they use. They provided documents showing medication shipping delays.
VA's website says prescriptions "usually arrive within three to five days" of being ordered or even an average of "60 hours from filling to delivery," and advises veterans to request refills at least 10 days in advance of running out. That estimate appeared consistent with the normal wait times veterans described to Connecting Vets, and some vets said they have yet to see significant delays.
But in recent weeks, dozens of veterans said they faced wait times that have doubled, tripled or worse. Some reported wait times as long as three weeks or more for prescriptions that previously took a few days. None of them have been contacted by VA with an explanation, they said.
"What used to take days now takes weeks," one said.
"We depend on these medications," another veteran said. "This could be devastating. I can't go without."
"I received my life-saving medication 20 days late," another said.
"I ordered five weeks early, expecting delays," another veteran said. "My meds were still late."
Others said they saw delays in delivery of medical equipment, in addition to medications.
Veterans said they were worried about going to VA facilities to refill prescriptions because of the COVID-19 pandemic, especially for those at higher risk.
"I'm immunocompromised and am trying to avoid going out at all, especially into a clinic," one veteran said.
"VA is telling us to stay home and canceling appointments, but wants us to come in to refill prescriptions?" another veteran said. "I wouldn't feel safe."
Some veterans said their healthcare providers told them in recent telehealth appointments that their only option to receive their medication was through the mail, since VA is still steering veterans away from in-person visits to some of its facilities during the pandemic.
A VA pharmacy chief described the USPS delays for prescriptions as "critical breaks in veterans' therapy," adding, "we are swamped with patient complaints over delivery delays."
Other VA staff who work in pharmacies across the country echoed those comments, saying they worried about the veterans who depend on medication for pain, depression, post-traumatic stress disorder and other serious physical and mental health concerns.
The pharmacy chief said VA has had "reports of veterans in withdrawal and/or off antidepressants that are experiencing relapse" but so far department leaders have not offered any solutions and USPS "is minimizing delays."
"So far we are on our own," the pharmacy chief said. "(We're) using lots of UPS and FedEx overnight when we know someone is short."
But local VA facilities can only do so much when they only fulfill up to 20% of prescriptions, compared to the 80% fulfilled at VA's centralized mail order facilities.
Two leaders of pharmaceutical companies that contract with VA's mail-order pharmacy system confirmed to Connecting Vets that VA prescriptions have been delayed because of USPS issues.
VA's online My HealtheVet tool allows veterans to track their mail-order prescriptions. For some veterans who spoke to Connecting Vets, their medications have been sitting at post office locations for nearly two weeks with no movement.
So far, VA officials are providing little to no information about how the USPS delays are affecting the department's massive mail-order prescription system.
Connecting Vets tried multiple times to confirm with VA officials that the department is aware of delays for veterans' prescriptions.
VA Press Secretary Christina Noel refused to respond to those questions, saying only:
"VA always encourages veterans to order routine prescriptions in advance. When it comes to emergent prescriptions, VA fills them onsite or uses commercial carriers to ensure timely delivery."
Noel referred any other questions to USPS.
USPS is now headed by a new Postmaster General, Louis DeJoy, who took over on June 15. DeJoy, a top donor to President Donald Trump, issued a memo during his first month leading USPS which mentioned the Post Office's continued financial struggles and announced new policies, including that the Post Office would now accept delayed mail to save costs.
"One aspect of these changes that may be difficult for employees is that — temporarily — we may see mail left behind or mail on the workroom floor or docks (in Processing and Distribution Centers), which is not typical," the memo reads, adding that USPS should avoid overtime payments caused by "late and extra trips."
The memo, first reported by The Washington Post, directed employees to leave mail behind at distribution centers if it would delay carriers on their routes. USPS warned customers months before DeJoy took over that the coronavirus pandemic could cause mail delays. USPS is one of the country's largest veteran employers.
Veterans and VA staff told Connecting Vets they did not begin seeing delays in mail-order prescriptions until July.
VA staff said they worried about the patients waiting for medications who are at highest risk.
"We already have a suicide problem," one said. "Missing antidepressants isn't good. (Missing) maintenance meds for blood pressure or anticoagulants can be catastrophic."
"We don't want to see someone get sicker or even die because of mail delays," another said. "This is completely avoidable."