Mail copays are flat-dollar amounts for a 90-day supply of medication. Historically, copays have offered an advantage over coinsurance in mail-service pharmacies because payment for prescriptions is made before the dispensing and shipping of the drug. Mail pharmacies are most commonly used for medications used to treat chronic conditions such as diabetes, high blood pressure, and high cholesterol. Average copays ranged from $22 for generics to $162 for specialty medications (Figure 24). From 2010 to 2011, copays increased across all drug categories (Table 19). As with retail 30, the largest range in copays was observed for specialty medications, with a low of $33 and a high of $500 (Table 20).
While up to three times the days supply can be dispensed via mail, member copays are usually discounted to incentivize members to use mail. The ratio of mail to retail 30 copays ranged from a high of 2.5 for brand drugs to a low of 1.9 for specialty medications (Figure 25). Across all categories, these ratios are lower than that observed for retail 90 claims. In other words, members are being provided greater copay discounts for mail pharmacies than they are for retail pharmacies.
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