Letter to Larry Merlo, President and Chief Executive Officer of CVS Health, - Key House committee launches Investigation into impact of Postal Service changes on prescription drug deliveries

Letter

Dear Mr. Merlo:
Given increasing reports of mail delivery delays and pursuant to Rules X and XI of the
U.S. House of Representatives, the Committee is investigating the impact of recent changes
within the U.S. Postal Service (USPS or the Postal Service) on the delivery of mail-order
prescription drugs to patients throughout the United States.1
We have serious concerns that the
Trump Administration's restructuring efforts within USPS, occurring as the nation faces the
coronavirus disease of 2019 (COVID-19) pandemic, may be leading to delivery delays of
prescription medications, adversely affecting the health of millions of Americans who depend on
the Postal Service to receive their medications.
As the Committee of jurisdiction over the approval and coverage of prescription drugs in
the United States, we are concerned by reports that these changes within USPS have negatively
impacted the delivery of medications to patients who need them.2
Our concern is further
heightened given that these changes began while the nation continues to endure the public health
threat of COVID-19. As a result of the pandemic, mail services are even more essential as many
Americans continue to follow social distancing guidelines and remain at home to mitigate the
spread of the virus. Since July, Postmaster General Louis DeJoy has sought to implement operational
changes within USPS, as well as to overhaul the Postal Service's executive management team.3

According to a series of memos that have since been made public, these initiatives include
numerous "cost-cutting" measures such as reductions in employee overtime pay, new
requirements on mail dispatches and transportation schedules, and the removal of high-volume
mail-processing machines from USPS facilities around the country.4
While Postmaster General DeJoy announced on August 18, 2020, that he would suspend
changes to USPS until after the Presidential election on November 3, 2020, our concerns
remain.5
It is still not clear if changes already underway will be reversed, and if not, how they
may still impact patients who receive their prescriptions through the mail both now through
Election Day and beyond.
As cautioned by the President of the American College of Physicians (ACP), "A delay in
receiving a necessary prescription could be life-threatening. My patients who rely on their
insulin, or their inhalers, or any other type of medication can't wait weeks to see whether or not
their prescription will be delivered."6
In an August 17, 2020 letter to Postmaster General DeJoy,
AARP voiced similar concerns, noting that USPS "has proven to be a lifeline for older
Americans, especially those in rural communities as well as those with medical conditions who
are most at risk from the coronavirus." AARP further emphasized that "more than ever before,
people are relying on the USPS to deliver their lifesaving prescription medications…allowing
them to remain safely at home."7
According the National Association of Letter Carriers, "in ordinary times, the Postal
Service…handles 1.2 billion prescription drug shipments a year."8
A recent analysis found that
in March 2020 alone, the number of mail-order prescriptions grew by 21 percent as a result of
the pandemic, and as of this month, mail-order prescriptions accounted for 5.1 percent of the market.9
In fact, data published August 7, 2020 shows that mail-order prescription delivery
volume continues to be higher compared to last year.10
Given the increasing reliance on mail-order prescription delivery and the critical need to
ensure all patients are receiving their medications in a timely manner, we are writing to request
information to better understand how the changes within the Postal Service may have impacted
delivery of prescription medications and the health and well-being of Americans. These changes
are particularly worrisome in the midst of the COVID-19 pandemic and we are interested in
learning about both the impacts that have already occurred and what you anticipate happening if
the changes are fully implemented after the election.
As one of the largest pharmacy benefit manager organizations, as well as one of the
largest retail pharmacy chains, CVS Caremark and CVS Pharmacy, respectively, (CVS Health)
works directly with health plans to offer their enrollees mail-order delivery of their medications
to their home and provides home delivery services to its pharmacy patients. We therefore
presume that CVS Health has access to information and data demonstrating potential impacts
that changes within Postal Service may have had on home delivery services.
In order to assist the Committee's oversight efforts, we request that you provide the
following information and responses as soon as possible, but no later than September 11, 2020.
1. Please provide a description of the mail-order delivery services offered by CVS Health,
including the breakdown of supply duration for prescription refills (i.e. the percentage of
30-day and 90-day supplies filled).
2. Please provide any known demographic data for the enrollees and patients utilizing CVS
Health's mail-order delivery services for prescription medications, including by known
medical condition, age, race and ethnicity, income level, and geographic status, where
possible.
3. To the fullest extent that the following is known and available, please provide:
a. The total percentage and breakdown by enrollee type of prescriptions filled via mailorder delivery services by CVS Caremark each month for the period of March 2019
through August 2019 and March 2020 through August 2020, as well as the total
percentage of prescriptions filled via mail-order delivery services by CVS Pharmacy
each month for the period of March 2019 through August 2019 and March 2020
through August 2020.
b. The total percentage and breakdown by enrollee type of prescriptions filled via mailorder services delivered by USPS for CVS Caremark for each month for the period of
March 2019 through August 2019 and March 2020 through August 2020, as well as
the total percentage of prescriptions filled via mail-order services delivered by USPS
for CVS Pharmacy each month for the period of March 2019 through August 2019
and March 2020 through August 2020.
c. The range and average length of delivery time for mail-order delivery services by
CVS Caremark and CVS Pharmacy each month for the period of March 2019 through
August 2019 and March 2020 through August 2020.
d. The percentage of prescriptions filled via mail-order delivery services by CVS
Caremark and CVS Pharmacy for the period of March 2019 through August 2019 and
March 2020 through August 2020 broken down by type of enrollee, as well as
medication class and type, including specialty drugs. For each medication type,
please indicate and describe any time-sensitive factors, such as any storage
temperature considerations, that necessitate expedited delivery.
4. Has any official from the Postal Service or the Trump Administration consulted with
CVS Health regarding the changes to the Postal Service or inquired about the potential
impact on mail-order prescription delivery services? If so, please provide further
information regarding this interaction, including the first date of the related interaction.
5. Has CVS Health received complaints--anecdotally or through formal channels--from
health plans or employers, enrollees, patients, or customers regarding delays or lost mailorder delivery prescriptions since Mach 2020? If so, please detail these accounts,
particularly indicating the number of complaints per month as well as whether there was
a notable increase beginning in July 2020.
6. Should Postmaster General DeJoy's operational changes within the Postal Service, such
as restricting delivery transportation schedules and bundling mail services, not be fully
reversed or be implemented further after November 3, 2020, what potential impacts on
prescription drug delivery and American's health could occur? What actions, if any, is
CVS Health intending to take to mitigate any adverse impacts?
Thank you for your prompt attention to this manner. If you have any questions about this
request, please contact Jacquelyn Bolen and Jesseca Boyer of the Majority staff at (202) 225-
292

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