OTC dealers don't have to make orders as often or as big, because they hedge.
Actually, that makes me think of something... so, when is the crypto-hedge-fund going to be a thing? They would be very helpful partners for the OTC dealers.
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Alt coins crypto market is very volatile. In this case to prevent risks dealers must have hight commissions and rates should be differ up to a few percents from Poloniex exchange provider. I can't say for all the OTC dealers, but on http://Changelly.com we have only 0.5% fee. That's why almost all the deals are hedging, especially for high amounts to exchange.