There’s a growing concern about the rising cost of pharmaceuticals, but you may be able to save at the pharmacy. Despite your health insurance, you may be paying more than you need to fill your prescriptions.
A recent study by the University of Southern California Schaeffer Center for Health Policy & Economics found that 23% of the time, customers overpaid for their prescriptions. The average overpayment, the study revealed, was $7.69 per prescription.
How and why does this happen? It’s a practice called “claw back.” Many, but not all, pharmacy benefit managers (PBM), go-betweens that handle drug claims for insurance companies take the extra funds, that average of $7.69 per transaction mentioned above, from the pharmacy fulfilling the prescription.
Pharmacy benefit managers, according to Kaiser Health News, include large by-mail pharmaceutical providers, which may use claw back practices. (It should be noted that the USC study also found that Express Scripts and CVS Caremark do not use claw back practices.)
How Claw Back Works
The fulfilling pharmacy charges you the amount of your insurance co-pay for prescription drugs, say $10 per. If the particular drug actually costs more than $10, the rest is covered by the insurance company. But if the actual cost of the drug is less than that $10 copay, the PBM keeps the difference. If your drug costs $5 and your copay is $10, for example, the PBM “claws back” the $5 difference.
Sometimes Out-of-Pocket is Cheaper
If you want to pay less where possible, you can find out what the drug actually costs. Ask your pharmacist if an out-of-pocket cost is less than your copay, and pay whichever is the least.
Some insurance plans have a gag clause that prohibits pharmacists from telling patients the non-copay cost. However, more and more states are prohibiting gag clauses. The National Conference of State Legislatures offers a tally of which states prohibit gag clauses and which have such laws pending.
If You Want to Save
When you want to find out if your drug is cheaper out-of-pocket, it can pay to ask your pharmacy. You can also go online to sites such as GoodRX.com to find the non-copay cost of the drug at various pharmacies.
To find out more about how to save money, read How to Find the Most Affordable Health Insurance.