Pharmacy benefit managers argue that mail-order pharmacies are less expensive for healthcare plans and patients. Not so, says the National Community Pharmacists Association.
Pharmacy benefit managers (PBMs) argue that mail-order pharmacies are less expensive for healthcare plans and patients. Not so, says the National Community Pharmacists Association (NCPA).
Mail-order pharmacies owned by major PBMs dispense generics 10% to 13% less frequently, according to data provided by the PBMs. In 2010, retail pharmacies dispensed generics 72.7% of the time, while the mail-order dispensing facilities for the 3 biggest PBMs sported dispensing rates of 60.5% to 61.5%, according to SEC filings by Medco, Express Scripts, and CVS Caremark.
For example, in 2010 there were 94 million prescriptions of simvastatin, the generic alternative to the cholesterol drug Zocor. In 2006, there were only 14 million prescriptions of simvastatin, according to IMS Health. In fact, the total generic drug market share compared to that of branded drugs has risen significantly over the last 5 years, according to IMS Health. Of the top 25 most prescribed drugs in 2010, 22 are generics and only 3 are branded drugs. Of patients who started therapy in 2010 for chronic conditions, 3.2 million more patients began with a generic product, while 6.6 million fewer patients started therapy with a brand.
In addition, contrary to what the big PBMs say, retail pharmacies can save healthcare plan sponsors more money than mail order can, French said. "It is egregious when you have PBMs' mail-order pharmacies incenting the high cost of brand drugs by asking health-plan sponsors to pick up the cost of brand drugs. It makes sense to pick up co-pays for generics; it doesn't make sense to pick up the co-pays for brand drugs," French said.