Van Nuys and her colleagues at the University of Southern California Schaeffer Center for Health Policy & Economics launched a study to see if Americans are overpaying for their prescriptions. They found that customers overpaid for their prescriptions 23 percent of the time, with an average overpayment of $7.69 on those transactions.
In the study, they looked at the prices of 1.6 million people who paid for 9.5 million prescriptions.
It showed that the overpayments totaled $13 million during the first six month period.
The study found that the pharmacy benefits managers like, Express Scripts, CVS Caremark and OptumRx, are “clawing back” the extra money from the pharmacy.
So when your pharmacists take your insurance card and ask for a co pay of $10, you may assume that that means your prescriptions costs more than $10 and your insurance is covering the rest. In actuality, the drug only costs $7 and the pharmacy benefits manager claws back the left over $3. If you would have paid out of pocket, you would have gotten a better deal.
The National Community Pharmacists Association, of which Hoffart is a member, said the new research “is illustrative of just one of many ways that PBMs’ lack of transparency disadvantages pharmacy patients. … If you want to reduce prescription drug costs, policymakers must demand greater transparency from PBMs.”
Patients should ask if paying for their prescription without their insurance would be cheaper for them.
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