Nearly 4 million Medicare-eligible Americans face heightened risk of disrupted medication access as restructuring efforts by the U.S. Postal Service slow mail delivery in rural and underserved communities reliant on mail-order prescriptions, according to a Dec. 4 analysis from The Brookings Institution
In 2024, USPS launched its Regional Transportation Optimization initiative, which consolidates mail processing into regional hubs. While the initiative aims to improve efficiency, early analyses suggest it has exacerbated delivery slowdowns in rural areas, according to the report.
To assess how these changes may affect mediation access, Brookings analyzed 2019 data on prescriptions for asthma and diabetes medications alongside measures of pharmacy access and postal infrastructure.
About 3.7 million Medicare-eligible Americans — or 6% of U.S. residents — live in areas with limited access to retail pharmacies, high reliance on mail-order prescriptions and inclusion in USPS’ restructuring effort. The analysis also found that mail-order pharmacy use rises by about 20% for every additional 10 miles between a patient and the nearest pharmacy.
“In these largely rural areas, even small changes in mail speed or reliability can interrupt medication schedules and undermine the management of chronic disease,” Brookings wrote. “The resulting ‘triple burden’ analysis illustrates how the postal system functions as a critical — if often overlooked — component of the nation’s health infrastructure, and how operational changes designed for efficiency may carry unintended health consequences.”
View the full analysis here.
