MAIL ORDER
Finding the Right Prescription for Mail-order Sales
How easy is it to obtain contact lenses without a valid prescription from leading mail-order and Internet companies?
By Randall Teague, OD, Fred M. Arima, OD, FAAO, Judson Briggs, OD, Don R. Cloninger, OD, Janet M. Mint, OD, FAAO, Gary J. Morgan, OD, John D. Pearson, OD, David W. Rouse, OD, and Alan Kurfirst, OD

Many vision-corrected consumers now purchase their eyewear, specifically contact lenses, without leaving home by shopping online and over the telephone. Although this shopping method may save patients time, money and hassle, it may present some potential risks.

The main issue is that many mail-order and Internet contact lens sales go through without proper prescription verification. It also appears that many mail-order and Internet companies use different criteria and methods for verifying prescriptions based on lens manufacturer requirements.

We tested the Bausch & Lomb, CIBA Vision, CooperVision, Ocular Sciences (OSI) and Vistakon lens prescription verification processes by ordering their lenses through top mail-order and Internet companies.

The objectives of our study were:

• To better understand how mail-order and Internet companies verify prescriptions for different manufacturers' products
• To determine the availability of contact lens brands through mail- order and Internet companies
• To determine the availability and possible substitution rates of private-label contact lenses by mail-order and Internet companies

Figure 1. Mail-order and Internet companies filled orders for most manufacturers' lens products without verifying prescriptions.

Study Methods

This study focused on the attempted purchase of five top-selling contact lens brands: Vistakon's Acuvue 2, CIBA Vision's Focus 1-2 week, Bausch & Lomb's Soflens 66, CooperVision's Frequency 55 and OSI's Biomedics 55.

We also tested the availability of Medflex, Perspecta, Polysoft, Softmed, Ultraflex and Versaflex (six popular private-label brands from OSI available through national optical retailers and their affiliated practitioners). We made purchases through the top five U.S.-based mail-order and Internet companies, which collectively represent approximately 90 percent of the contact lens mail-order and Internet industry.

An independent company that specializes in product investigations was contracted to employ "buyers" who made 422 purchases of the target products. We assigned each buyer to purchase a selection of the five brand name and private label products from selected mail-order and Internet companies between May 14 and June 30, 2003. The buyers resided in 10 states across the country. These buyers did not have valid contact lens prescriptions to place their orders. Buyers tracked their own orders while we tracked any attempts by the mail-order and Internet companies to verify the prescriptions.

When placing orders, each buyer named one of us as the prescribing doctor. Each of the 11 practices used a formal tracking system to ensure accuracy. Aware of the day, the product and the mail-order or Internet company through which the attempted purchase would be made, we tracked any attempt by the mail-order and Internet companies to contact our offices either through a faxed verification inquiry form, a personal phone call or an automated phone call. If the companies contacted us, then the respective office denied the prescription by saying it was invalid. We also tracked when we did not receive any communication from the mail-order or Internet company involved.

The study took place over the course of seven weeks and used normal purchasing patterns and quantities. Therefore, these results represent what patients, customers and practitioners experience on a daily basis. Additionally, because these companies represent approximately 90 percent of the mail-order and Internet industry, these results should accurately reflect the marketplace.

	Figure 2. Mail-order and Internet companies used different methods to verify prescriptions for different manufacturers. NOTE: Only invalid RX's used

Results

Purchases Received Results show that of the 422 attempted contact lens purchases made without a valid prescription, companies routinely verified only those for Vistakon products with the doctor. Between 89 percent and 96 percent of all orders for CIBA Vision, Bausch & Lomb, CooperVision and OSI products were ordered, shipped and received without a valid prescription. Companies dispensed only eight percent of Vistakon products ordered using invalid prescriptions (Figure 1).

Verification of Prescriptions Prescription verification methods used by the mail-order and Internet companies varied among manufacturers (Figure 2). Companies verified 64 percent of orders for Vistakon products using faxed forms. They dispensed between 68 percent and 78 percent of prescriptions for CIBA Vision, Bausch & Lomb, CooperVision and OSI products with no attempted verification.

Mail-order and Internet companies attempted to verify orders for CIBA Vision, Bausch & Lomb, CooperVision and OSI products through phone calls 22 percent to 32 percent of the time. Of those phone calls, 46 percent, 69 percent, 58 percent and 87 percent (respectively by manufacturer) were automated. Ninety-seven percent of the prescription verification phone calls we received for Vistakon products were personal calls rather than automated, which allowed us to respond to the verification request.

When mail-order and Internet companies attempted to verify prescriptions for CIBA Vision, Bausch & Lomb, CooperVision and OSI products, we responded that the buyers' prescriptions were invalid. Even so, the mail-order and Internet companies dispensed these lenses approximately nine out of 10 times (Figure 1).

Product Availability Of the five manufacturer brands purchased for the study (not including private label brands), 100 percent were available through mail-order and Internet companies.

Private Label Brands OSI is a leading manufacturer of private-label contact lenses, which are "exclusive" products designed to indirectly help eyecare practitioners and retailers retain patients. Buyers attempted to purchase Medflex, Perspecta, Polysoft, Softmed, Ultraflex and Versaflex, which are all equivalents of OSI Biomedics 55 brand. Seventy-eight percent of the time, mail-order and Internet companies indicated that they could substitute Biomedics 55 for the requested private-label brands (Figure 3). The companies advised patients that Biomedics 55 lenses are equivalent to the six private label brands.

Mail-order and Internet companies did not have the OSI brand in stock 16 percent of the time and therefore did not complete the transaction. They referred orders for those lenses to other mail-order and Internet companies for fulfillment six percent of the time. We instructed "buyers" to not purchase lenses from referred sites.

Figure 3.

Discussion

This study indicates that inadequate verification systems for four of the five contact lens manufacturers regularly allows most of their lenses to be dispensed without valid prescriptions. Mail-order and Internet companies, as a general rule, consistently verify prescriptions for only Vistakon products.

As practitioners know, prescription expiration dates notify patients that it is time to have their eyes re-examined and their vision-correction devices monitored. We feel that patients who wear Vistakon lenses are more likely to return for an eye health examination because of the prescription verification process in place for Vistakon products.

Before this study, we did not anticipate any significant difference in the way mail-order and Internet companies dispensed brand-name contact lenses. But our findings suggest that CIBA Vision, Bausch & Lomb, CooperVision and OSI do not have an effective system in place to ensure that their products are dispensed with a valid prescription.

Based on our data, Vistakon is the only manufacturer that has effectively implemented a prescription verification process that mail-order and Internet companies follow.

Study results also indicate that automated phone calls, which represent the primary mode of contact that mail-order and Internet companies use to verify Bausch & Lomb, CooperVision and OSI products, are an ineffective way to verify prescriptions. Each of us who participated in this study found that automated calls were typically inaudible, did not clearly state the patient's name and failed to make clear our next course of action.

We preferred to communicate with mail-order and Internet companies by fax. We felt that this gave us more flexibility to respond, ensured more accurate communication about the patient's data and provided a copy of communication for the patient's chart. We believe that it was essential to respond to help ensure the patient's eye health.

We were all surprised at the availability of OSI products at mail-order and Internet companies. Moreover, contrary to popular belief, OSI private-label brands are also available through mail-order and Internet companies because they are substituted at the point of sale for the parent brand, Biomedics 55. This contrasts what many practitioners believe about private-label contact lenses -- that they retain patients and increase contact lens businesses through "exclusive" lens sales.

Conclusions

The results of this study indicate that:

• Only one of five manufacturers appears to control how its products are sold and distributed through mail-order and Internet companies. This difference results from the contact lens prescription verification requirements the manufacturer has in place for its products
• All manufacturer brands included in this study were widely and readily available through mail-order and Internet companies
• Mail-order and Internet companies substitute private label lenses with the manufacturer's branded equivalent
• Mail-order and Internet companies appeared to honor our prescription verification responses for only one of the manufacturers' products

We encourage all manufacturers to take responsibility for how their products are distributed and dispensed. A required prescription verification process should encourage patients to return to their eyecare practitioner for regular eye examinations.

This study was sponsored by Vistakon, a Division of Johnson & Johnson Vision Care, Inc.