Mail Order Pharmacy
What You Don’t
Know Will Hurt You!
Mail Order Pharmacy
Builds a case for savings through:
• Perceived Discounts
• Not Actual Dollars
Example:
Brand Name Prescription
• Retail Pricing
AWP – 14%
• Mail Pricing
AWP – 22%
Brand Prescription
• Retail
• Mail Order
AWP - $100.00
AWP – 14%
100.00 – 14.00 = $86.00
AWP – 22%
100.00 – 22.00 = $78.00
$8.00 Savings
Mail Order
Alters or Uses Higher AWP Products
• Retail
AWP – 14%
100.00 – 14.00 = $86.00
• Mail Order
AWP – 22%
150.00 – 33.00 = $117.00
- $31.00
Example
Generic Prescription:
DMG
Retail
MAC
MAC 1
MAC 2
MAC 3
MAC 4
MAC 5
Generic
Drug 1
.20
.30
.40
.50
.60
.70
Generic
Drug 2
.50
.75
1.00
1.10
1.25
1.35
Retail Pricing: MAC Pricing
set at $0.20 x 60 = $12.00
Mail Pricing: AWP – 50%
AWP = $1.00 x 60 = $60.00
60.00 - 50% = $30.00
- $ 18.00
Co-Pay Issue
Pfizer Study
$30.00
• Retail co-pay
X
3
$90.00
• MAC co-pay
$30.00 / per one 3 month
supply
Payer picks up $60.00 of cost.
*If prescription is not $60.00 cheaper, then government costs go up.
Lipitor - Redbook
Repackaging Example:
Lipitor 20mg #30
• At Retail
• At Mail Order
Pharmacy Paid
AWP-14% + $2.00
Pharmacy Paid
AWP-22% + $0.00
AWP* = $4.16/tablet
30 x $4.16 = $124.80
AWP* = $6.81/tablet
30 x $6.81 = $ 204.30
$124.80 - $17.47 + $2.00 =
$109.33
$204.30 - $44.95 + $0.00 =
$159.35
$50.02 more at Mail Order vs. Retail
*2007 Red Book Pricing