The cost of prescription drugs is on the rise every year. With insurance benefits proving to be more costly to employers, companies are finding ways to cut costs. One-way is increasing the amount the employee pays out of pocket (in both co-pays and deduction from paychecks). The other is requiring employees to use mail order pharmacy services rather than the tradition retail pharmacy services. General Motors Corporation saved $80 million in 2005 by making mail-order pharmacy mandatory. It is a move that companies large and small are leaning towards, and most employees will be affected.
What It Costs:
A retail pharmacy deals with every level of prescriptions; this includes emergency, compounds and maintenance medications. By trade, retail pharmacy has produced some great profits. Companies like Walgreen’s, CVS, Rite-Aid and Brooks are considered the “Big Four” of pharmacies. CVS operates the largest number of stores in the United States, expanding down south and west to California. Walgreen’s does the highest volume of prescriptions in the United States. It has consistently ranked number one in customer satisfaction for the past five years.
A Pharmacy Benefits Managers typically runs a mail order pharmacy. Companies that are PBMs include Medco and Aetna. Though run by the specific insurance company, certain aspects are outsourced to other companies. These mail order pharmacies are for maintenance medications, also known as “chronic conditions” such as high cholesterol, high blood pressure and diabetes. They are not for emergency medications, such as an emergency room visit resulting in pain medications for a broken bone or antibiotics your child may receive a prescription for an ear infection or strep throat.
Most insurance plans allow two fills of a maintenance medication per year at a retail pharmacy for a 30-day supply. After this, you must set up a mail order account through your respected insurance company. Normally, a letter when enrolling in a certain prescription plan will explain this to you.
There are many money saving advantages using mail order:
-Medications shipped directly to house saving gas money
-Larger days supply
The day’s supply is a major difference between mail order and retail. Some people will pay only two co-payments for a 90-day supply, some even one co-payment as compared to three at the retail pharmacy level.
On a sample insurance plan, a 90-day supply for Lipitor, the nation’s number one prescribed drug via mail order would be $40 as compared to $60 or better at a retail level.
What the pharmacist says:
At a retail pharmacy your are able to receive a personal touch. When you have a question about your medication, you can ask us right on the spot. We are always available and knowledgeable to help you.
In many cases we are the first to get cost-saving generic drugs saving you money, rather than costly brand names through mail order.
We offer a personalized service that people know they cannot get from an insurance company. If you go and fill a brand new prescription for a drug you have never taken before, it can be pretty daunting. There is so much information to look through; most of it is very difficult to understand. If I am standing right there at a consultation area, you can go ahead and ask me a question. I can explain to you, in layman’s terms some of the most difficult questions you have. I can also ease your tension and nerves about adding a medication to your daily regimen. With mail order, we tend to believe that you receive a pamphlet in mail, but there is nobody to ask questions too. We get many, many mail order customers calling or coming in asking us questions. Either the pill they have looks a little bit different, or they don’t understand specific directions on how to take a medication. We are basically the go-betweens for doctors. With mail order, you don’t have that luxury or comfort. Sometimes, trying to get a hold of a real person at an insurance company is like waiting on hold with your cable company.
The Snitch Says:
The insurance companies whom you receive your mail order from have a registered pharmacist (RpH) on call 24 hours a day via telephone or email. In fact, the majority of those working for mail order pharmacies worked as pharmacists in the “Big 4” pharmacies. They find that there is much less tress and red tape by working in claims, overrides and the mail order department.
As far as being the first to receive generic drugs, this claim is unfounded. Retail pharmacies receive the generic drugs of companies that they are in “cahoots” with. Mail order pharmacies typically do not have the bureaucratic red tape. They also are able really counsel you about a switch to a generic drug. Retail level pharmacies tend to overlook this, and switch your prescription automatically to generic if it suits them.
In 2003 the growth of mail order pharmacies outpaced the total prescription growth according to a PBM study. Retail pharmacies are trying to generate sales, but have been failing to do so, leaning more on front store sales. Some pharmacies, no matter what, will fill for a 30-day supply, even if the insurance company, under a slight chance, might pay for more. If the pharmacy gives you only 30, they know you will be back that same time next month. If you give them a 90-day supply, that’s a lot of money that company can be losing. Imagine if they fill 700 plus prescriptions a day.
Mail order can fill about 5,000 or more prescriptions a day. In a warehouse where this is taking place, there is no stress of the hone ringing or people coming to the counter with questions. At a retail pharmacy it is easy to lose focus, socialization with customers, personal phone calls while checking prescriptions, they are all major contributors to mistakes by pharmacists. Many television magazine programs have investigated mistakes at retail pharmacies. Some reporters brought in prescriptions that would be very dangerous if filled together. In pharmacy terms a “level 1 contraindication,” but only a handful of pharmacists were able to catch the contraindication.
Unlike what the pharmacist said, mail order pharmacies can call out to clarify prescriptions to clarify, just like retail pharmacist. However, mail orders have an advantage, they can look at every single claim the person has made for a prescription and see if there are any discrepancies. In the days of doctor shopping and pharmacy shopping, retail stores are not able to fully know the customers medical history.
Retail pharmacy is a $70 billion dollar a year industry, increasing about 20% over the last two years. Mail order pharmacies easily double that rate.
If you are on maintenance medications or will be starting to take them, call or check out your insurance companies website. Websites now over personalized service, so you know exactly what your formulary is, and if you plan has mail order. Make sure your doctor always writes out a 90-day supply on all your maintenance medications. This way you can send the prescription right into the insurance company with no hassle. It also saves you money. They can always fill for less than the quantity the doctor prescribed, but not for more.
If your policy includes mail-order, use the retail pharmacy only as a last resort or emergency medications. If your mail-order prescription does not come on time, most insurance companies will pay for a 14-day supply at no or minimal charge at a retail pharmacy. Just as the pharmacy technician to call to get an override from the company.
Make sure you know your formulary. Although doctor’s offices are provided with copies of an insurance companies formulary, most never use it. Doctors tend to prescribe based on recent drug suggestions (whether it be a drug rep from a pharmaceutical company or a journal they may have read) When going to a retail pharmacy the most common line will be “well we do not know each person individual plan.” This is why you must know it, so that you are not taken advantage of.
Just Because You Were Curious:
How much does a pharmacist make anyway?
The average pay for pharmacists nationwide is over $100,000 annually. In certain areas, new pharmacists receive healthy sign-on bonuses ranging from $5000 to $20000 in some cases. Retail chains, trying to suppress the pharmacist shortage have even agreed to pay for housing over a long period of time if a pharmacist will move. An hourly wage for a pharmacist is around $48/hr. Many do not work full 40-hour weeks. Schooling can range from six to eight years. Some schools, such as the Massachusetts College of Pharmacy offer a four-year, fast track program. More and more schools are finding that students intend to enter the pharmacy program. This makes getting into certain programs much more difficult than in recent years. With it being listed at the top-paying profession, it can be expected that the number of students will continue to rise, as will the salaries.