A snowstorm that swept western Missouri last year left a patient waiting on critical medication they needed to ward off seizures.
That patient ended up in a hospital to deliver a dose of the drug.
Now, with an increasing number of rural residents relying on mail service to get their prescriptions — and the U.S. Postal Service set to cut some services to more remote areas — medical professionals worry about the consequences.
“What I’m concerned about from a rural health standpoint,” said Tessa Schnelle, the director of pharmacy at the Cass Regional Medical Center in Harrisonville, Missouri, “is some of the things that we even see now with mail order becoming more exacerbated.”
The USPS didn’t meet its delivery goals in Missouri this year. Now, to save more than $3.5 billion a year, the Postal Service announced a “Regional Transportation Optimization” plan that would centralize service around regional hubs like Kansas City and St. Louis.
Instead of twice-a-day pickup and drop-off at local post offices, the USPS is planning to reduce those services to once a day.
The Postal Service says the plan could mean an additional day in transit for some mail. Medical professionals in Missouri say that slowing the mail could threaten the ability of their patients, particularly in rural areas, to get timely delivery of prescriptions that are critical to their health.
Postal Service officials promise that deliveries should still reach mailboxes within current delivery times. But after delays and spotty service, Missourians fret that things will get worse.
Goals for delivery time lowered
The change in services comes as many Americans embrace mail-order prescriptions and as rural pharmacies close their doors.
Between 2018 and 2023, retail pharmacies in rural communities decreased by nearly 6%, a study
from the RUPRI Center for Rural Health Policy Analysis found. It’s a nationwide trend in rural and urban areas: pharmacies in urban areas declined by 3.4% over the same time.
New 2025 delivery target information published by the Postal Service found that it fell short of its fiscal year 2024 delivery goals. The 2024 targets called for delivering a single piece of first-class mail within two days after it’s dropped in a collection box 93% of the time. Actual deliveries hit that mark 86.9% of the time.
Now, the Postal Service lowered the targets to 87% for the budget year that started in October.
In Missouri and Kansas, the percentage of mail that met the two-day first-class mail delivery goal fell to 85.9% in 2024 from 90.4% in 2023.
“The Postal Service has … decided that the best way to achieve targets is to lower them,” Steve Hutkins, a retired English professor wrote on his Save the Post Office website. “Expect things to get worse before they get any better.”
The Missouri Farm Bureau and U.S. Sen. Josh Hawley criticized the proposal, saying USPS is prioritizing urban customers over rural ones.
How could the USPS plan impact patients?
The slowdown and missed targets trouble Schnelle as she works to support her rural patients.
An additional day in processing medication could present challenges for patients whose insurance companies don’t refill medications before a certain time. That makes it less likely that a patient would be able to call in their prescription early if they are anticipating delays in the mail.
“I don’t see it being a positive impact for patients,” Schnelle said.
And worries persist that more medications might go bad if deliveries take longer. Many medications are sensitive to temperature changes that could make them less effective, Schnelle said.
The Missouri Rural Health Association said it is too early to tell how much the plan may impact service, but the group’s executive director has concerns given service disruptions she’s seen over the past few years.
“I’m not sure if this is necessarily the answer to make service delivery better,” said Heidi Lucas, the group’s executive director. (Lucas sits on The Beacon’s board of directors.) “If medication is lagging and not in a climate-controlled environment for a couple of days as it awaits delivery, that could be a massive problem.”
USPS is currently making the case for the plan to the Postal Regulatory Commission, which doesn’t have total power to veto the changes. The commission is expected to release a nonbinding opinion on the plan in January.
Most prescriptions delivered through the mail are sent first-class. A top Postal Service official told the commission in October that single-piece first-class mail would be slowed the most by the changes. That means that 68% of first-class mail volume in rural communities could see potentially slower services.
The plan comes as USPS started to walk back some other consolidation proposals in September for Florida, California and Tennessee, which would have slashed some operations at local offices.
That walkback was considered a win by the American Postal Workers Union, which criticized the “chaotic implementation of changes” to the USPS.
The union said despite the reversal in California, Florida and Tennessee, it’s advocating for mail to be processed locally.
“The union has consistently advocated that mail generated in a local area, for delivery in the local area, should stay and be processed and sorted in the local area,” the APWU wrote in a press release.
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