AMCP believes that payors must have the flexibility to use mail service delivery of prescription drugs as a component of their prescription drug benefit. Mail service pharmacies are a valuable tool used to increase patient safety, meet the rising consumer demands for medication delivery, improve patient adherence, and maintain the affordability of the prescription drug benefit. Additionally, it has been utilized as a convenient and valuable option to ensure prescriptions can get to the right patient in situations where patients are home-bound, which was validated in recent years as a result of quarantine and lock-down procedures. Payors should also have the ability to set patient cost‐sharing levels for prescription orders filled through mail service pharmacies different from the patient cost‐sharing levels for prescription orders filled through retail pharmacies.
Mail service pharmacies allow patients to have a choice as to how they obtain and what they pay for their medications. While some prescriptions, such as those for acute indications or for a new therapy, are appropriately filled in the retail setting, once a patient’s therapy is established, mail service pharmacy is a convenient, cost‐effective way for the patient to receive their maintenance medications. Patient safety may be improved when using mail service pharmacies, as dispensing error rates are lower at mail service pharmacies than at retail pharmacies. Studies also suggest that patients using mail service pharmacies have higher adherence rates than patients using retail pharmacies. Increased patient adherence to medication regimens improves patient outcomes and reduces overall health care costs.
In addition to providing patients with a choice in how they obtain their prescriptions, mail service pharmacies can also help payors manage the costs of the prescription drug benefit as a whole. As a result of high‐volume purchasing, mail service pharmacies are frequently able to secure lower costs for prescription drugs. The administrative and dispensing fees may also be lower for claims dispensed through mail service pharmacies. Mail service pharmacies can also increase generic substitution rates and formulary adherence, leading to lower net costs. These cost savings may be passed on to the payor and the patient.
Similar to lower cost‐sharing requirements for generic drugs compared to their brand‐name counterparts, payors will frequently encourage mail service pharmacy by setting lower cost‐ sharing amounts for prescriptions filled via mail service. Proposals that would prohibit offering lower cost‐sharing to patients who prefer to receive their prescription drugs via a mail service pharmacy deprive patients of an effective way to save money on prescription drug costs. Preventing these cost‐savings from being passed on to a patient who chooses a mail‐service option is inconsistent with the goal of lowering out‐of‐pocket drug costs for consumers. AMCP could consider cost‐sharing parity appropriate only in instances where a retail pharmacy is willing to accept the same terms and conditions accepted by the mail service pharmacy.
See also:
AMCP Where We Stand series: https://www.amcp.org/policy-advocacy/policy-resource-center/where-we-stand-position-statements
Revised by the AMCP Board of Directors, March 2022
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