How Mail-Order Pharmacies Help Bridge the Gap in Pharmacy Deserts—But Not All Are Created Equal

In the U.S., nearly 60% of adults rely on at least one prescription medication, and at least one-third of people take three or more prescriptions. As the population ages and chronic conditions rise, prescription demand is surging. Yet access is shrinking. 

 “Pharmacy deserts” – areas without a pharmacy within 10 miles – are becoming increasingly common, especially in underserved communities. Meanwhile, the three largest pharmacy benefits management (PBMs) companies control nearly 80% of all prescriptions filled in the U.S., further limiting choice and access.

Mail-order pharmacy is a powerful solution, when it's done right. The best mail-order services don’t just ship prescriptions; they offer high-touch care, clinical support, and the kind of personal attention patients typically associate with a local pharmacy. For employers, choosing the right mail-order partner isn’t just about convenience, it’s a strategic move toward better care, health equity, and lower costs.

The Disappearing Pharmacy: A Nationwide Challenge

While data models estimate that 96% of Americans live within a 10-mile drive of a pharmacy, these models are theoretical and often don’t represent the reality of the situation. More than 13 million people fall outside that range, and many more, despite being geographically close, still struggle to access essential medications due to transportation limitations, physical barriers, and systemic inequities. For employers, these access issues have real consequences, from increased absenteeism to higher long-term health care costs. Ensuring your pharmacy benefits plan includes a mail-order option that centers patient care isn’t just compassionate, it’s smart business.

The growth of these “pharmacy deserts” across the country is due to a multitude of reasons, including: 

• The widespread loss of small, independent pharmacies in favor of larger, consolidated corporate chains.
• The dominance of the “big three” PBMs, which now control nearly 80% of all prescription fulfillment in the U.S.
• Limited access to reliable transportation and public transit in both urban and rural areas.
• Accessibility challenges faced by older adults and people with disabilities.

These forces have created more than just a market shift, they’ve led to a systemic failure. As the big three PBMs squeeze margins and dictate networks, local pharmacies disappear. “When you lose an independent pharmacy, it’s not just the medication, it’s the personalized care that goes with it,” said Nithya Shankar, Vice President of Innovation at True Rx Health Strategists. “Everyone at a community pharmacy, from the CEO to the front counter staff, knows their patients. That makes a big difference. For employers, it’s essential to partner with and promote mail-order pharmacy services that preserve this same level of personalized, high-touch care—because convenience should never come at the expense of connection or quality”.

Mail-Order Pharmacies: A Scalable Solution for the Future of Access, Affordability, and Continuity

As more brick-and-mortar pharmacies close, particularly in underserved areas, employers and brokers should view mail-order pharmacy services as a powerful tool to improve access, reduce costs, and enhance employee satisfaction. Mail-order isn’t just convenient; it’s a strategic advantage that supports better health outcomes and a stronger bottom line.

In response to this growing crisis, True Rx Health Strategists has partnered with innovative mail-order pharmacy providers like Mark Cuban Cost Plus Drug Company and WB Rx Express to bring transparency, affordability, and personalized care back to pharmacy services. These partnerships focus on empowering patients through accessible pricing, clinical support, and a high-touch experience that transcends traditional pharmacy care.

As Mark Cuban shared in a webinar with True Rx CEO, Mark Williams, RPh, “The more I got into this industry, the more obvious it was that the big three PBMs were abusing small town pharmacies.” Cuban’s company collaborates with True Rx and WB Rx Express to challenge this trend, promoting a model where local access, quality care, and affordability are prioritized over profits.

These partnerships reflect our belief that mail-order pharmacy should do more than just deliver medications—it should empower both patients and employers with personalized, forward-thinking solutions that change the world of health care. By addressing the fundamental needs of access, affordability, and adherence, these services go beyond logistics and directly impact patients' health and well-being. Here's how:

Accessibility

By delivering medications directly to patients’ homes, mail-order pharmacies remove barriers related to distance, transportation, and pharmacy hours, offering a critical lifeline for rural, elderly, disabled, and underserved populations. These services are especially vital for patients who rely on specialty medications, which often require temperature control or other special handling. Mail-order pharmacies are equipped to meet these requirements, ensuring medications arrive safely and intact. “If a patient can receive their prescription by mail, it eliminates the worry about distance, transportation, or the time it takes to get to a pharmacy,” Shankar said.

“I live in Ohio and I’m getting mail-order from Indiana quicker than I was getting it from my local pharmacy” - a patient with mail-order service WB Rx Express. 

Affordability

Bulk purchasing and wholesale pricing allow mail-order pharmacies to offer meaningful savings, especially on 90-day prescriptions that reduce refill frequency. With mail-order, a patient could expect an estimated annual savings of $60*. These savings support both patient affordability and employer cost control.

“When someone is taking these medications for complex conditions, there is also the whole cost aspect of keeping a patient out of the hospital,” said Shankar. “That level of preventative care saves lives, improves health outcomes, and reduces healthcare costs as well.”

Transparent pricing is also a key advantage of some mail-order models. Mark Cuban’s Cost Plus Drug Company, for example, uses a simple and honest pricing formula:

“Every product we sell is priced exactly the same way: our cost plus 15%, plus the pharmacy fee, if any,” said Cuban. “When you get your medicine from Cost Plus Drug Company, you’ll always know exactly how we arrived at the price you pay. And as we grow and our costs go down, we will always pass those savings on to you.”

That level of pricing transparency is not only rare in the traditional pharmacy model, but also essential for building trust and ensuring long-term affordability.

Medication Adherence and Support

Nonadherence, when patients don’t take medications as prescribed, is a costly and dangerous issue. Mail-order pharmacies help address it through: 

• Auto-refills and synced deliveries.
• Fewer trips or orders to manage.
• Clinical guidance and support for patients managing complex regimens.

“By syncing refilled medication into a single delivery, patients avoid the hassle of managing endless shipments", said Clay Williams, Chief Executive Office at WB Rx Express. "And the high-touch pharmacist care provides guidance on side effects, proper use, and more can make a real difference. Patients deserve someone in their corner to navigate treatment."

Patients notice the difference in service quality, too. “A real live person answers the phone and is willing to answer any questions or concerns I have. Feels like I’m talking with my best friend!” said Jennifer, a patient with mail-order service WB Rx Express.

“Not all mail-order pharmacies are created equal, so patients should find an option that works for them, someone who puts an emphasis on patient care,” said Shankar. “Mail-order pharmacies can guide patients on how to correctly administer medications, answer questions about side effects and much more.” 

What to Look for in a Mail-Order Pharmacy

Not all mail-order services are created equal. Choose one that puts patients first. Look for:

• Convenience and savings: without locking members into rigid plans.
• People over profits: a focus on care, not just the bottom line.
• Transparent pricing: clear, competitive, and honest costs.
• Independent service: high-touch, personalized support.
• Clinical integrity: care quality never sacrificed for cost-cutting.

A Smarter Prescription Strategy for the Future

Given the health care access crisis unfolding in communities across America, mail-order pharmacy services are more than a convenience, they’re a critical part of the solution. From expanding access in underserved areas to helping employers lower costs and improve outcomes, the case is clear.

The bottom line: Mail-order pharmacy is the next evolution of care. But it’s not just about delivery, it’s about restoring trust, advancing equity, and ensuring that no one is treated like just a number. Employers, brokers, and healthcare leaders have a responsibility, and a real opportunity, to champion pharmacy models that put people first.

*Based on 2024 True Rx internal data. Savings will vary by plan design.