Mail-order pharmacies are a cornerstone of the nation’s prescription delivery network, particularly for chronic conditions that require consistent access to medication. By eliminating travel barriers and providing longer-fill prescriptions—usually 60- or 90-day supplies rather than the typical 30—mail order supports regular treatment routines that are central to chronic-disease management. The value of mail-order prescriptions, threatened by USPS network changes, links the performance of the postal network directly to the continuity of pharmaceutical care, making changes in speed or reliability of the postal network a serious health care issue, not just an inconvenience to post office customers.

In recent years, the United States Postal Service’s (USPS) has launched its Delivering for America strategic plan to modernize its network and reduce costs. One key element, the Regional Transportation Optimization (RTO) initiative introduced in 2024, consolidates mail processing into regional hubs. While intended to improve efficiency, early analysis by oversight bodies like the Postal Regulatory Commission warns that delivery slowdowns may be unevenly distributed, particularly in rural areas where dependence on mail-order pharmacies is highest, showing how USPS network changes are threatening access to prescription drugs.

Using near-universal prescription transaction data for asthma and diabetes medication in 2019, this report maps where and for whom mail-order medication is most prominent. Combining these data with measures of pharmacy access, postal infrastructure, and exposure to the RTO identifies where multiple vulnerabilities overlap. Roughly 3.7 million Medicare-eligible Americans live in communities where three risks to medication access converge: limited retail pharmacy access, heavy reliance on mail-order prescriptions, and exposure to postal service restructuring. In these largely rural areas, even small changes in mail speed or reliability can interrupt medication schedules and undermine the management of chronic disease.

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.

Understanding the Operational Changes and Geographic Impact of the Regional Transportation Optimization in the Context of USPS Network Changes

The Delivering for America (DFA) plan, introduced in 2021, outlines the U.S. Postal Service’s 10-year strategy to modernize operations and restore long-term financial stability. The plan emerged after years of operating losses driven by declining mail volumes and the broader shift towards digital communication. One of the plan’s core objectives is to reduce costs and improve efficiency across the delivery network while maintaining universal service coverage. The Regional Transportation Optimization (RTO), rolled out in 2024, is a key part of this effort.

Read the full article about USPS network changes by Elena Patel, Joshua Feng, and Matthew Higgins at Brookings.