Similar to previous years, 30% of responding employers said they were willing to supply their confidential pharmacy reimbursement rates. The survey collects reimbursement data for retail, mail and specialty pharmacy dispensing channels, as shown in Table 23. 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 42% of employers for retail 30 generic prescriptions, 24% for retail 90 generic prescriptions, and 18% of employers for mail-service generic prescriptions (Figure 28).
As shown in Table 23, the average generic discount ranged from 57% for retail 90 to a high of 69% for mail. The brand discount was also highest for mail at 23%, followed by retail 90 at 19.4%. Discounts for specialty drugs remain significantly lower than other brand medications, averaging 16%.
Dispensing fees for retail 30 averaged $1.54 for brands and generics and were just under $1.00 for retail 90. For mail, 88% of reporting respondents did NOT have a mail dispensing fee. Accordingly, mail-service reimbursement data are divided into two groups: employers with dispensing fees and employers with no dispensing fees, as detailed in Table 24.
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