Robert I. Garis
Creighton University
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Research in Social & Administrative Pharmacy | 2009
Bartholomew E. Clark; Mark V. Siracuse; Robert I. Garis
BACKGROUND Little evidence has been presented to date that would either support or refute a widely held belief that mail-service pharmacy utilization routinely produces savings in drug benefit costs for prescription benefit plan sponsors. OBJECTIVE To present a comparative analysis of mail-service and community pharmacy service drug benefit costs for 5 employer-sponsored prescription drug benefit plans. METHODS A cross-sectional comparison of 17,725 matched transaction pairs of community and mail-service prescriptions from a data set comprised 484,987 prescription claims from a convenience sample of 5 employer-sponsored prescription benefit plans. Differences between community pharmacy and mail-service prescription transactions were examined at the per-unit level of analysis for drug ingredient costs, dispensing fees, co-payments, dollar amounts paid by plan sponsor, and total dollar amounts. RESULTS Overall, the total cost of prescriptions was lower through mail-service pharmacies for all 5 plans studied. Two of 5 plans had co-payment incentives to use mail-service, yet plan sponsors paid more for mail-service drugs; respectively, 4.5% and 8.3% more overall, 25.0% and 21.4% more for generic medications; and 3.0% and 7.0% more for brand name medications. Mail-service co-payments were 48.9% and 51.7% lower. Mail-service utilization rates were 15.2% and 31.5% of the total number of prescriptions dispensed in the period studied. Three of 5 plans had no co-payment incentive to use mail-service and paid less for mail-service drugs; respectively, 18.7%, 6.6%, and 15.7% less overall; 17.4%, 15.6%, and 7.9% less for generic medications; and 18.8%, 5.2%, and 16.6% less for brand name medications. Mail-service co-payments were 10.5% more, 5.2% less, and 1.8% more than community pharmacy co-payments, respectively. Mail-service utilization rates were 0.8%, 1.2%, and 4.4%. CONCLUSION Co-payment incentives to use mail-service pharmacies instead of community pharmacies were associated with higher mail-service utilization rates and with higher costs to plan sponsors. Absence of a co-payment incentive to use mail-service pharmacies was associated with lower mail-service utilization rates and with lower costs to plan sponsors.
Journal of The American Pharmacists Association | 2004
Robert I. Garis; Bartholomew E. Clark
OBJECTIVE To document the difference between what pharmacy benefits management companies (PBMs) charge employers and what they pay dispensing pharmacies for the drug ingredient portion of prescription transactions (the spre DESIGN Descriptive, cross-sectional study. PARTICIPANTS Two large employer groups, each of which used a different PBM, and six independent community pharmacies participating in these plans during 2002. INTERVENTIONS Two sets of financial records issued by each of two PBMs were reviewed retrospectively, including 129 line-item prescription transactions billed to the employer and the line-item transaction information that accompanies the PBM payment to the dispensing pharmacy. MAIN OUTCOME MEASURE Spread between drug ingredient cost billed to the employer by the PBM and drug ingredient cost paid to the dispensing pharmacy by the PBM for brand name versus generic drug products. RESULTS For both PBMs, the mean (+/- SD) spread was dollar 12.29 +/- 27.93 per prescription, with a range of -dollar 1.67 to dollar 201.65. Considering all 129 transactions, the mean spreads for brand name and generic medications were significantly different from one another, with mean (+/- SD) spreads of dollar 4.65 +/- 10.47 and dollar 23.45 +/- 39.47 per prescription, respectively. The two PBMs differed significantly in their spreads for brand name drugs (dollar 3.20 +/- 2.85 and dollar 5.93 +/- 14.12), but the spreads for generic products did not achieve statistical significance in absolute dollars (dollar 10.83 +/- 13.58 and dollar 31.74 +/- 48.11) because of their greater variation (as reflected in the larger standard deviations). However, the percentages difference for generic products differed significantly. CONCLUSION This pilot study indicates the possibility of substantial and widely varying differences in the spread and spread percentage between PBMs for brand name and generic medications. A more transparent business model for the PBM industry could produce better relations with PBM clients and business partners, including community pharmacies.
American Journal of Health-system Pharmacy | 2004
Robert I. Garis; Bartholomew E. Clark; Mark V. Siracuse; Michael Makoid
Journal of Health Politics Policy and Law | 2008
Christy A. Rentmeester; Robert I. Garis
American Journal of Health-system Pharmacy | 2008
Mark V. Siracuse; Bartholomew E. Clark; Robert I. Garis
Archive | 2005
Robert I. Garis; Bartholomew E. Clark; Mark V. Siracuse
Research in Social & Administrative Pharmacy | 2005
Robert A. McLean; Robert I. Garis
Journal of Health Politics Policy and Law | 2008
Christy A. Rentmeester; Robert I. Garis
Archive | 2007
Mark V. Siracuse; Bartholomew E. Clark; Robert I. Garis
Archive | 2004
Robert I. Garis; Bartholomew E. Clark; Mark V. Siracuse