Pharmacy reimbursement is currently comprised of two elements: Average wholesale price (AWP) for the drug ingredient(s) and a dispensing fee for the pharmacist services. In exchange for the volume of prescriptions associated with group drug plans, pharmacies extend a percentage discount off of AWP to employers and other drug benefit plan sponsors.
The survey collects reimbursement data for retail, mail and specialty pharmacy dispensing channels as shown in Table 38. The average percentage discount off of AWP for mail generic prescriptions is collected because not all employers apply maximum allowable cost (MAC) pricing to generic prescriptions dispensed by mail-service pharmacies. MAC pricing is used by 70.6% of employers for retail generic prescriptions and 45.5% of employers for mail-service generic prescriptions, a decrease since 2008.
Review findings on:
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