Mail-order pharmacies can lessen generic usage, study finds

Mail-order pharmacies are associated with less generic substitution than community pharmacies, according to a new study published in Therapeutic Innovation & Regulatory Science. The research, funded by an FDA grant, examined the determinants of generic substitution and found that in five of eight therapeutic classes, patients using a mail-order pharmacy had less generic substitution than patients filling prescriptions at community pharmacies. The researchers said the use of a mail-order pharmacy and less generic substitution "was most extreme" for stimulant and thyroid hormone drugs, as well as for anticoagulants, ophthalmic drugs, and estrogens. The researchers noted that PBMs can negotiate lower prices on brand products for the big mail order pharmacies and big chains because they are such large purchasers. Mail-order pharmacies also receive rebates from manufacturers based on their ability to influence a drug's market share for a significant number of consumers. The researchers concluded that mail order pharmacies, as often required by PBMs, "lessen generic use for many classes. These pharmacies may require additional regulatory oversight if this adversely impacts patients."

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