Mail order services have always been depicted as a cost
reduction strategy for pharmacy plans, but the untold truth is it’s not. While
most PBM contracts show a greater discount at mail order, it’s important to
note that it is usually a greater discount on a greater cost.
Retail drug pricing begins with what is called the MAC
(Maximum Allowable Cost), this is a ceiling cost on most generic medications.
For example, Amoxicillin 500mg, a commonly prescribed antibiotic, typically
wouldn’t cost an employer a MAC greater than 50 cents per pill.
Retail outlets shop around to use
the drug manufacturer with the lowest costs. This makes business sense as it is
a necessity to keep operating costs low. However, mail order facilities are not
retail outlets, and have different business priorities. Mail order
facilities may use just ONE manufacturer which may not always be offering the
lowest cost. If they use MAC pricing at all, it is substantially
different from retail Mac and it is not uncommon to see a prescription filled
at a mail order facility cost 3 times more than retail.
There are alternatives to a Mail Order network that can
generate actual plan savings. Let APC negotiate aggressive discounts on the
plan’s lowest MAC setting. APC can help design a plan that can provide
your members with convenience and true savings across the board.
If you’re unsure what type of networks your PBM will allow
or need guidance on choosing a plan that fits, please contact an APC consultant
for a complimentary plan review.
