Many mail-order companies are using products made especially for them in easy to use package sizes - These units have their own NDC number, not the manufacturers.
They also are to assign their own AWP's to these products which are inflated 10-40%. There are some pharmacies that are choosing to also dispense repackaged products. Not all plans will accept claims submitted with repackaged NDC numbers, but some plans will adjudicate and pay for these claims. This can be viewed as discrimantory pricing.
Please re-read contracts and provider manuals in regard to the sale of repackaged products. One plan manual reads " may not reimburse a Pharmacy, or may reduce reimbursement for repackaged products submitted with a higher AWP than the original manufacturer's product...the third party may reverse the entire claim.." In other words, you are taking the chance that the claim can be recouped entirely.
Audits charging back on claims submitted for repackaged products have occured ---- BUYER BE WARE
Keystone has been approached from such a company recently and we have rejected their proposal..
PPA & Keystone have sent proof of this practice to the State Attorney General by mail-order which is costing the Commonwealth many millions of dollars. No response as of this date, but it has only been a few months.