I don't understand the whole mail order thing. The other day I had a patient whose refill was denied because she "must use refill." I looked at her history and saw that last time we had billed them $10 for the prescription, they negotiated it down to $6.xx, and they didn't actually pay anything. How are they saving money by filling and mailing out a prescription compared to paying nothing? I know mail order is more efficient in terms of labor, but they have to bag and pay postage for everything that goes out. I don't have access to their books, or my own company's, for that matter, but it's not obvious to me that saving a few hours of labor with economies of scale is always going to beat a well-run retail pharmacy, when you consider that retail doesn't have to mail out every prescription.
I also see a lot of plans that only allow 30 day fills on even $4 drugs where they're paying nothing. The patient would actually pay less by getting it for cash for a 90 days supply for $10, but then the patient will never reach out of pocket maximums. This really doesn't benefit anyone. And making us triple our labor/supplies by filling the same thing three times, while filling 90 days supplies themselves, seems like they're sabotaging retail pharmacies.