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To: Glenn D. Rudolph who wrote (166)7/27/1999 10:27:00 AM
From: Firenze  Respond to of 254
 
Glenn,

Absolutely not. This is completely within the rights of the insurance (3rd party) carrier to design their product (beneift) as they wish. If they choose to increase the size of their network (i.e., increase access) then adding DSCM makes sense. Remember that for every prescription that is processed as mail-order, the 3rd party achieves a significant discount. Prescriptions processed by DSCM and PLRX will dilute that discount. Since the payer is the 3rd party, they can dictate who they pay and to what level. Think of this example:

If you are in a POS (Point of Service) medical plan you can go to any physician you like. However, if you go to in-network physicians you pay a copayment (usually $10-$20) per visit. If you go to an out-of-network physician you pay the full amount and submit the rest. You are then reimbursed by the insurance company at 70% or so, after you have met your deductable.

The same holds true for DSCM, think of them as an out-of-network pharmacy. If you are in an HMO plan there is no out-of-network benefit, therefore you pay the full price. Would you do that? I would not. Specifically, since I drive by 2 Walgreens and 3 Eckerds and numerous grocery stores on my way to and from work. I can pay $5 for generics and $10 for brand name formulary drugs at those in-network pharmacies.

When you take into consideration that most brand name drugs run for $60 and up per month, it is a no brainer for those with insurance. Also, just about every 3rd party offers mail-order and MMRx and ESRX and others all have on-line refill request systems as well as telephonic refills.

There is no advantage to offer another onliner.

Firenze