Comparison of costs of community and mail service pharmacy

To compare the costs of prescriptions dispensed through mail service and community pharmacies to quantify the comparative costs of the two types of pharmacies.

Modeling study based on 1-year of claims data from a cohort of patients.

A health plan in the northeastern United States.

Approximately 100,000 members of the health plan.

The plan used a small pharmacy benefits manager (PBM) and a mail service pharmacy that was not owned by a major PBM, a three-tier benefit design, and specified that patients could get a 90-day supply through mail service for the equivalent of two 30-day community pharmacy copayments.

Actual total, ingredient, plan, and patient costs of prescriptions dispensed through a mail service pharmacy and the estimated costs of those same prescriptions at community pharmacies.

Total costs for the 44,847 prescriptions dispensed through mail service were dollar 6,401,624. Had these prescriptions been dispensed at community pharmacies, costs would have been dollar 6,902,252. Ingredient costs were dollar 6,401,624 through mail versus dollar 6,633,170 at community pharmacies. Total costs to the health plan were dollar 4,726,637 through mail versus dollar 4,417,733 at community pharmacies. Member costs were dollar 1,674,987 through mail versus dollar 2,484,519 at community pharmacies.

Compared with community pharmacies, the mail service pharmacy was less expensive overall, less expensive for patients, but more expensive to the health plan. From the health plan's perspective, the loss of copayments in the mail service benefit was greater than the savings on ingredient costs and dispensing fees.