Pick-pocketing at the prescription counter

If you think you’re paying more for prescription drugs than you should, guess what?

You’re right.

A lot of people don’t realize it. But you might actually pay less if you buy those drugs without plunking down your insurance card first. Because often, the copays are higher than the out-of-pocket price of the prescriptions.

It’s true — and a new study from the University of Southern California Schaeffer Center for Health Policy and Economics recently revealed just how common it is. They discovered that patients are overpaying nearly a quarter of the time — by an average of $7.69 per prescription.

All in all, we’re talking about a total of $135 million in overpayments. And that’s just over the six-month study period alone.

So what’s going on here?

There’s a name for this practice — it’s called a “clawback.” An appropriately predatory term for the underhanded way pharmacies benefit managers — the middle-men responsible for overseeing drug plans, processing prescriptions, and negotiating prices — squeeze extra dollars out of the pharmacy. (And as you may recall, it’s not the only trick they have up their sleeves.)


It works like this: Let’s say your pharmacist charges you $10 for the copay listed on your insurance card. You would assume that the prescription costs more, and insurance is covering the difference. But that’s not always the case. In fact, that drug may actually cost only $7.


So in a way, you’re being penalized for using your insurance. Or perhaps the better term is exploited.


The National Community Pharmacists Association is calling this out for what it is — urging lawmakers to demand transparency from pharmacy benefit managers in the effort to lower drug costs and protect consumers.


But the Pharmaceutical Care Management Association — the trade group that represents the pharmacy benefit managers — said that overall, they bring down the cost of drugs for patient and insurers.


And in other news, the sky is orange. I mean, really… who buys this bull?!


This latest research saw the highest clawbacks with brand-name drug purchases. These transactions featured average overpayments of $13.46 per script. Generic purchases averaged clawbacks of $7.32.


But these are just averages. This study uncovered one instance where a patient was charged a copay over $42 for a generic statin drug. The out-of-pocket cost of the drug? About $19.


Interestingly, the drug with the highest rate of clawbacks was zolpidem tartrate — the generic form of the sleep drug Ambien. (Which — sadly, for many reasons — also happens to be one of the most prescribed drugs in the country.)


To make matters worse, pharmacists don’t typically volunteer this information. You’d have to ask them whether paying out-of-pocket is cheaper. And even then, there’s no guaranteeing they’d be able to answer that question. Not because they don’t know the answer, but because some insurance plans have gag clauses.


Yes, I said gag clauses — in other words, legal contracts prohibiting pharmacists from telling you that you’re being fleeced.


Six states have outlawed these kinds of clauses. And 20 more are weighing similar action. But given the scope of this problem, I’d hardly call those numbers reassuring.


If I’ve told you once, I’ve told you a thousand times. Big Pharma — along with all of their lackeys, from top to bottom — are in it for the money and nothing more. If your health is actually a concern to you, you’re better off taking your “business” elsewhere.

I’ve covered some of the most shocking secrets the medical industry doesn’t want you to know in my monthly newsletter, Logical Health Alternatives. Subscribers have access to all of it in my archives—and a whole lot more. Don’t let Big Pharma have the upper hand. Sign up today!