An emerging standard · forming

Your medication should arrive before your last dose.

When daily medicine ships by mail, a refill that goes out on time can still arrive after you run out — because a weekend or holiday delayed it. For some medications, a few missed days is catastrophic. It's preventable.

The No-Gap Guarantee: a daily medication dispensed by mail will be timed to arrive before the prior supply runs out — accounting for processing, transit, weekends, and holidays. No gaps. Guaranteed.
Be the first to sign Read the standard See the scorecard
The problem

A refill window built for the pharmacy counter, not the mailbox

Insurance refill rules release a refill only about a week before your prior supply runs out — a window designed for same-day retail pickup. In the mail channel, pharmacy processing plus carrier transit plus a single holiday weekend can outlast that window, so the package arrives after the last dose.

This is not a case against mail order. Mail-order pharmacy generally improves adherence, and most refills arrive on time. The concern is a specific, preventable tail failure — a consecutive multi-day gap on time-sensitive medications around holidays — whose significance comes from the severity of its outcomes, not its frequency.

Where a short gap is severe

Anticoagulants (clot, stroke), transplant immunosuppressants (organ rejection), HIV antiretrovirals (viral rebound and resistance), antiepileptics (breakthrough seizures), insulin.

Why the fix is nearly free

Timing the refill to arrive before runout changes when the medication is sent, not how much. The annual quantity dispensed is unchanged.

The standard

What signing the No-Gap Guarantee means

A pharmacy that signs commits to timing mailed maintenance medications to arrive before runout, with these requirements — and keeps every existing safeguard against stockpiling and double-billing.

  1. Delivery-date anchoring — compute each patient's runout date and ship early enough to arrive before it.
  2. Holiday- and weekend-aware scheduling — a maintained carrier calendar; ship ahead of blackouts, not into them.
  3. Runout prediction with proactive refills — trigger the fill early enough to clear transit.
  4. Scope — non-controlled daily maintenance medications; higher tiers include high-need specialty drugs (incl. HIV therapy), not only low-cost generics.
  5. Prorated cost-sharing for any bridge fill — no patient charged twice.
  6. Existing stockpiling controls retained — the buffer prevents gaps without letting supply drift.
  7. Patient transparency — show the expected arrival date; alert when a gap is projected.
  8. Public reporting — track and publish the share of fills that arrive before runout.
🥉 Committed

Publicly signs; meets the core requirements; self-attested.

🥈 Verified

Reports its arrive-before-runout rate; covers high-need classes.

🥇 Audited

Independently audited; full specialty scope, including HIV.

The scorecard

Who has signed

This list is public. It starts empty — and that's the point. Every pharmacy will be able to answer one question: do you guarantee your patients won't run out?

PharmacySigned?TierArrive-before-runout rateIncludes HIV / specialty?
No pharmacies have signed yet. Be the first.

Note: "auto-refill" programs that ship before runout are a partial step — they are not the guarantee unless they are delivery-date-anchored, holiday-aware, and publicly reported.

Get involved

Sign it. Join it. Or help measure it.

Pharmacies & plans

Be the first to sign the guarantee. We provide the full standard, the implementation spec, and the supporting analysis — and you get credit for leading.

Patients, clinicians & advocates

Add your voice and your story. A coalition that holds pharmacies to this standard has to be led by the people it protects.

Get in touch
Honest status. This is an emerging, patient-led standard, not yet a finished program. We are deliberately measuring the open question first — how often mailed medications actually arrive after runout, especially for patients already on auto-refill — before scaling. The standard above is published so the work is transparent from the start.