As U.S. Postal Service delays grow and spread, the Department of Veterans Affairs is rushing to get prescriptions to veterans on time.
The vast majority of VA prescriptions are fulfilled by mail from a group of seven massive, automated hub pharmacies across the country, the Consolidated Mail Outpatient Pharmacy (CMOP) system. That centralized pharmacy system processes about 80% of all VA outpatient prescriptions, and 90% of those are shipped through USPS. The other prescriptions are typically filled at local VA medical facilities.
VA's mail-order pharmacy system 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.
Connecting Vets first reported the delays, according to dozens of veterans, VA pharmacy staff and pharmaceutical company leaders, on Wednesday. By Friday, nearly 100 veterans and caregivers, along with dozens of VA employees, pharmaceutical leaders and USPS staff confirmed that Postal Service issues are delaying veterans' medications.
This week, VA told Congress it plans to mitigate the medication delays by sending prescriptions earlier, according to sources with knowledge of those conversations. VA is developing a communications plan to inform veterans of the possibility of delays and that the department plans to send prescriptions out for delivery earlier than expected.
VA told Congress that USPS delays may be worse in some areas, including New York, New Jersey, Arizona and Michigan. In those areas, VA is converting its deliveries from USPS to UPS 2nd Day Air or FedEx temporarily.
VA also is setting up a new USPS code to help the Postal Service identify and prioritize veteran prescription deliveries. That code is already in place for first-class and priority mail packages, and the two agencies are working to expand it to other mail categories.
Many of the veterans and staff who reached out to Connecting Vets spoke on condition of anonymity because they said they feared retaliation from the department, stigma for the medications they use or were not authorized to speak publicly. They provided documents showing medication shipping delays, internal memos and more. Most said they had not yet heard from VA about delays. Some said healthcare providers warned them during recent telehealth appointments to order refills earlier and that mail-order was their only option, as some VA facilities are still limiting visitors because of the coronavirus pandemic.
Veterans and their caregivers told Connecting Vets they've 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. Others said medical equipment deliveries were also delayed. Many expressed concerns about going to VA in person to retrieve medications during the pandemic.
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.
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 veterans with chronic health conditions 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" and neither USPS or VA leaders have provided specific solutions.
"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.
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 weeks with no movement.
"I had to get an emergency refill from my doctor who was good enough to do it," one veteran said.
"I have been experiencing medication delays with little to no assistance offered from the VA," said a Florida veteran, who added that while VA advises veterans order refills before they run out, not all medications can be ordered early. She's gone without some of her critical medication for a week. "Currently, I am experiencing adverse side effects from not having my medication and I have only been offered reassurance that 'it's on the way.' This is unacceptable. Some veterans take life-saving medications. The VA needs a serious inquiry into how to prevent this issue from continuing."
Another veteran said going without his prescription for a week because of USPS delays landed him in the hospital.
"They've never been late," he said of his mail-order prescriptions. "They often show up early ... This time, I had to wait and I thought I could make it through until they arrived but I was wrong."
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, with nearly 100,000 veterans on staff (about 15% of the total USPS workforce). About 60% of the veterans working at USPS have a disability rating, the agency estimates.
This week, Capitol Hill Democrat leaders, House Speaker Nancy Pelosi and Senate Minority Leader Chuck Schumer, called for an investigation of USPS delays in a letter to DeJoy and for DeJoy's recent policies to be reversed to avoid further delays.
Cole Butterfield, an Army veteran and American Postal Workers Union leader in Oregon, said postal workers nationwide tried to warn USPS leaders of the dangers of delaying mail, including prescriptions for veterans, seniors and people with disabilities. He said his wife is a disabled veteran who relies on USPS for her medication.
"That has now come to pass," he said. "Parcel volumes are at or above Christmas volumes. However, even first-class letter mail is being delayed in many installations ... The delaying of mail is troubling and borderline criminal. In the past, workers have been disciplined or fired for delaying mail. The USPS provides a vital service to all Americans, especially to our veterans.
"I assure you that postal workers nationwide are outraged. We care about the mail and we care about our customers."