What you don’t know can hurt you: uncertainties in georeferencing
Mail Order Pharmacy What You Don’t Know Will Hurt You!
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Transcript of Mail Order Pharmacy What You Don’t Know Will Hurt You!
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.
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