
CVS Caremark’s Maintenance Choice program makes mail and retail dispensing channels economically equal (“channel neutral”) for consumers by eliminating the out-of-pocket cost difference for a consumer between mail and retail for 90-day maintenance prescriptions.
As far as I know, this peer-reviewed academic article contains the most complete public disclosure about the actual operations of the MC program. These data go far beyond satisfaction surveys by showing the actual choices in a channel neutral situation.
Read on to find out what happened in a sample of 325,000 people with this benefit design. Then ask, how can you incorporate these real-world behavioral insights into your marketing plans?
As always, I suggest you read the full article for all of the details: Revealed Preference for Community and Mail Service Pharmacy. Free to JAPhA subscribers; everyone else will have to buy it.
Revealed preference is a fancy way of saying: “Watch what people do, not what they say.” With this idea in mind, the authors observed the behavior of 324,968 commercially insured patients who were newly enrolled in “a plan that allowed them to purchase 90-day supplies of chronic medications at either mail service or community pharmacies, with no differences in out-of-pocket costs for either channel.”
We all know the program as “Maintenance Choice,” although the paper never mentions the commercial name.
The patients were grouped into three cohorts:
- New to therapy
- Previous mail service pharmacy users
- Previous community pharmacy users
- More than two-thirds of consumers chose a mail pharmacy over a retail pharmacy. Put another way, consumers seem happy with mail based on their actual (voluntary) behavior.
- The decision to use mail was heavily influenced by a consumer’s prior use of a retail or mail pharmacy for maintenance prescriptions. Previous mail users tended to stick with mail and previous community pharmacy users tended to stick with community pharmacy.
- For new maintenance prescriptions, more consumers chose mail than chose a retail community pharmacy.

- 76% of previous mail pharmacy users stayed with a mail pharmacy
- 66% of previous community pharmacy users stayed with a community pharmacy
- 56% of new therapy users chose mail pharmacy.
These data are neat because they go beyond satisfaction data, which have been controversial and often used in a misleading way. If you’re curious about pharmacy satisfaction, see these articles from the Drug Channels archives:
Given the high voluntary adoption rates of mail, these data make me wonder about Walgreens (NYSE:WAG) campaign to convince consumers to fill 90-day prescriptions at a Walgreens retail pharmacy instead of a mail-order pharmacy. See Walgreens Joins the Attack on PBM Mail Profits.
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FYI, Mr. Gary Lee Weinrib studied this issue many years ago. As he noted in his research: "If you choose not to decide, you still have made a choice." See for yourself...