In January 2010, New Yorker Enrique Menendez received a surprise notice from CIGNA, his health insurance company, telling him he must now get some of his dozen-plus prescriptions from a mail-order pharmacy rather than his local one. He's not alone. Increasingly, major insurance plans don't just offer the cost-saving mail-order option—they may require it for “specialty” medications (drugs, often expensive, for complex conditions).

The mail-order system, one company says, provides “clinical support for better health outcomes…[and] makes these medications accessible and affordable for you and your employer.” Ideally, mail order would make getting drugs easier (you can often order refills online), with cheaper co-pays (up to half off) and improved privacy.

In reality, problems can arise. It took Menendez, HIV-positive since 1989, five months to obtain all his meds properly. Packages went missing, or he wasn't home to receive them. Maintaining adherence became a daily battle of phone calls and e-mails. At times he was left without meds.

“In 22 years, I've never had such a problem,” Menendez says. “It's really been breaking my spirits.”

It's also risky, adds Tim Horn, AIDSmeds editor-in-chief. Through Oxford, Horn must now get his HIV combo—which has multiple potential drug interactions—by mail order, but his other meds in person. “One pharmacist won't know what the other is filling,” he says. “So now I have to watch for dangerous drug mixes?” 

Walter William Ryder, owner of the Hilltop Pharmacy in northern Manhattan, says he has lost a good third of his top-dollar medication business to mail, aiding many unhappy customers make the transition in the process.

Ryder calls the mail-order system “sort of like Communism—great on paper, but as soon as you add humans into the mix, it gets screwed up.” Prevent those human errors with the tips at right.