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To: Glenn D. Rudolph who wrote (159)7/26/1999 11:27:00 AM
From: Firenze  Read Replies (1) of 254
 
Glenn and Tom,

If you remember my note a few weeks back that mentioned that DSCM would not be able to fill all the same prescriptions that RAD can. The reason is this, Pharmacy Networks are developed at the discretion of the HMO or third party payor. Since each Pharmacy has an NABP (National Associations of Boards of Pharmacy) number, third parties can cherry-pick which pharmacies they want in the network. The contracts that RAD has with third-parties are not assignable and in many cases specifically state that the pharmacy be a free-standing pharmacy (i.e, not mail-order).

You see, each PBM/third-party already contracts with mail-order vendor and has extremely aggressive contract rates, rates that DSCM will not be able to touch. In some cases, the third-party (if it is an HMO), has additional discounts directly with the manufacturer.

I have been saying for sometime that the vast majority of business that DSCM will see from an insurance perspective will be from RAD's PCS division (about 50 MM members). Highmark is a Merck-Medco client (I think, check your card for [PAID]), therefore, You will never be able to get your prescription filled at your plan copayment using DSCM, because MMRx has not and probable will not allow DSCM into it's network of pharmacies. It has the largest mail-order business in the US.

Glenn, as you stated below, unfortunately you have no shot at moving an insurance company to include DSCM in you network. It makes no economic sense for them!

Firenze
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