Mail Order Pharmacy What You Don’t Know Will Hurt You!

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 AWP - $100.00• Retail AWP – 14%

100.00 – 14.00 = $86.00• Mail Order AWP – 22%

100.00 – 22.00 = $78.00

$8.00 Savings

Mail Order

Alters or Uses Higher AWP Products

• Mail Order AWP – 22%150.00 – 33.00 = $117.00

• Retail AWP – 14%100.00 – 14.00 = $86.00

- $31.00

Example

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

Generic Prescription:

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

• Retail co-pay

Pfizer Study

• MAC co-pay

$30.00

X 3

$90.00

$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:Repackaging Example:Lipitor 20mg #30Lipitor 20mg #30

• At RetailAt RetailPharmacy Paid Pharmacy Paid

AWP-14% + $2.00AWP-14% + $2.00

AWP* = $4.16/tabletAWP* = $4.16/tablet

30 x $4.16 = $124.8030 x $4.16 = $124.80

$124.80 - $17.47 + $2.00 = $124.80 - $17.47 + $2.00 = $109.33$109.33

• At Mail OrderAt Mail OrderPharmacy Paid Pharmacy Paid

AWP-22% + $0.00AWP-22% + $0.00

AWP* = $6.81/tabletAWP* = $6.81/tablet

30 x $6.81 = $ 204.3030 x $6.81 = $ 204.30

$204.30 - $44.95 + $0.00 = $204.30 - $44.95 + $0.00 = $159.35$159.35

$50.02 more at Mail Order vs. Retail

*2007 Red Book Pricing