To the Editor-in-Chief:

In reference to: “Mail Order Pharmacy Policies Put Nearly Half of Veterans with HIV at Risk of Missing Doses” published online for U.S. Medicine in July 2017:

The recent U.S. Medicine on-line article by Annette M. Boyle entitled “Mail Order Pharmacy Policies Put Nearly Half of Veterans with HIV at Risk of Missing Doses”, which was informed by a recent article incorrectly reports that VA’s mail order pharmacy policy limits the days’ supply of HIV medication that veterans can obtain from VA’s mail order pharmacies[1].

The title of Ms. Boyle’s article is unnecessarily inflammatory and nothing can be further from the truth- VA does not have a mail order pharmacy policy that puts veterans at risk and further, data from one VA facility is not representative of the VA system as a whole.  In fact, for the period covering October 1, 2016 through June 30, 2017, 62 percent of all HIV medication prescriptions filled in VA’s mail order pharmacies were filled in greater than one-month supplies.

To be clear, decisions about the quantities of medications to be dispensed and whether those medications are to be dispensed by a VA medical facility pharmacy or by a VA mail order pharmacy rest solely with the VA physicians and pharmacists who are providing care, not with VA mail order pharmacy personnel.  Presumably, these prescribing and dispensing decisions are based on discussions between Veterans and their providers with a goal of optimal medication adherence and ensuring Veterans stay connected with their providers.

We would also like to point that veteran patients have recognized VA’s mail order pharmacies as the highest ranking mail order pharmacy in the United States for 6 of the past 7 years, having missed first place in 2016 by 1 point out of a possible 1000. We encourage any veteran who reads this article to discuss their medication supplies with their VA provider at their next visit to ensure they have adequate supplies of medications available to them.

Mario Franchi 
Deputy Chief Consultant CMOP
Pharmacy Benefits Management Services
CMOP (770) 
5409 S. 13th Street
Leavenworth, KS. 66048

Michael Valentino
Chief Consultant
Pharmacy Benefits Management Services
Department of Veterans Affairs
810 Vermont Avenue NW
Washington, DC 20420

[1] Desai KR, Chewning B, Wilcox A, Safdar N. Mail-order pharmacy experience of Veterans living with AIDS/HIV. Res Social Adm Pharm. 2017 Feb 24. pii: S1551-7411(17)30098-0. doi: 10.1016/j.sapharm.2017.02.00

Response from the editorial director: U.S. Medicine has written numerous articles in the past about the good performance of the VA’s mail-order pharmacy system. This report was not intended to be a broad review of the system but simply information about a new study. Details included in the article came from the study and an interview with one of the co-authors.


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