The United States Postal Service has been at the heart of a bitter partisan divide over the last few months of COVID-19 and the U.S. election season.

Prominent Democratic politicians have alleged that recent reforms and administrative changes ushered by recently appointed Postmaster General Louis DeJoy have led to widespread service delays across the country. At the same time, President Donald Trump has repeatedly signaled to the media that he is against emergency funding injections sought by Democrats and the USPS, which is expected to face extended difficulties in the coming months due to the combined pressure of mail-in ballots and COVID-19 disruptions.

In a statement published yesterday, DeJoy said that the USPS would be suspending some of the reforms in question until after the election. But while the service's role in the election is on the forefront of many Americans' minds, patients and medical professional organizations alike have voiced immediate and long-term concerns about the 1.2 billion prescription drug shipments handled by the USPS annually.

"Across the country, and especially in rural areas, Americans are not receiving critical prescriptions," the Council of Medical Specialty Societies wrote in a statement published yesterday. "Without timely access to their medications, Americans may be forced to make avoidable emergency department visits or be hospitalized. Given the COVID-19 pandemic, it is extremely important that every effort be made to reduce unnecessary exposures."

From the industry's perspective, the impact of these delays has so far been mixed. Cigna's Express Scripts told MobiHealthNews that it's "not currently experiencing any unusual delays" in the medication deliveries it provides through national delivery carriers. Humana Pharmacy, which also relies on the USPS, is "updating internal processes to reduce overall turnaround times" and "looking at additional ways to expedite shipments" in response to an increase in small-parcel shipping volumes, a spokesperson said.

Walgreens, which primarily works with FedEx and other local couriers, said it does not anticipate any medication delivery disruptions. Similarly, online pharmacy NowRx said that it handles its same-day delivery logistics in-house and would not be affected.

A representative of CVS Health said that the company is "closely monitoring the current situation," and highlighted its stance alongside the Package Coalition in advocating for USPS emergency-relief funding. Amazon's PillPack, also a member of the Coalition, said that it stays in communication with the USPS and other carrier partners to mitigate the impact of peak volume for customers.

But the contrast to these pharmacy cornerstones comes in responses from telehealth and online pharmacy platforms, some of which have been very vocal about the repercussions USPS interruptions have had on their customers and businesses.

Jessica Nouhavandi, cofounder and lead pharmacist of Honeybee Health, a Culver City, California-based online pharmacy delivering to 46 states, told MobiHealthNews that 20% of customers ordering first-class mail deliveries have experienced delays due to the USPS this summer.

"The situation is fluid but it's clear from our customer service team that an unusually high number of patients are receiving their medication far later than expected – and in some cases, not receiving it at all," she said in an email statement. "We're founded and run by pharmacists and pride ourselves on this. We have rave reviews on TrustPilot and historically received a maximum of a dozen complaints or so a week related to shipping issues. Now, we're getting hundreds. That's a huge jump for a business like ours." 

The concerns were echoed in statements from Simple Health, a provider of online prescriptions and deliveries of birth control. The company said it uses the USPS exclusively for its medication shipments, and has lately seen an increase in customer complaints regarding shipment delays. Further, the majority of Simple Health's patients purchase their contraceptives using insurance, meaning that the company is legally prohibited from adjusting refill timelines to counteract the delays.

“People using birth control, emergency contraceptives, and other prescriptions cannot afford a delay in access to their medication, and the Trump administration should know better than to play political football with critical prescription care," CEO Carrie Siubutt said in a statement.  "The House must work to pass a funding package for the U.S. Postal Service that gives Americans back their freedom to choose their prescription coverage and expect speedy delivery times despite the Trump administration’s agenda to attack and dismantle the USPS.” 

Other startups in the online telehealth and birth control space said their customers have seen little to no disruptions related to USPS services.

Ro, for instance, said that its partnership with another service provider has helped to avoid delivery issues. Nurx told MobiHealthNews that it has seen its average shipping times "slightly increase since March," that it offers its patients tracking information and local pharmacy pick-up options, and that it is now "closely monitoring any changes with shipping and delivery to ensure we set expectations appropriately with our patients."

But for those whose business models are entwined with USPS services, the current delays and future uncertainty could lead to changes down the line. Honeybee's Nouhavandi stressed that the USPS is "by far" the most cost-effective shipping option available.

"Using another service, such as FedEx, would increase the price significantly," she said. "But of course, if things continue like this, we’ll explore that option."

The more immediate concern has been replacements or refunds for the roughly 5% of Honeybee's shipments that haven't been arriving, Nouhavandi said. The company hasn't yet calculated the total cost to its bottom line, but reshipping and lost medication-acquisition costs resulting from the delays "are bound to have an impact" on the company's business, she said.

And although businesses may find themselves weathering the storm of new costs and damaged reputations, it's the patients relying on these services who face the greatest threat.

"These delays are troubling for everyone, but for patients who rely on medication to live, it's especially dangerous," Nouhavandi said.