Why a patient paid a $285 copay for a $40 drug

Consider asking what a prescription would cost out of pocket compared to what the copay would be, before getting it filled.

Insurance copays are higher than the cost of the drug about 25 percent of the time, according to a study published in March...

USC economist Karen Van Nuys, a lead author of the study, had her own story of overpayment. She discovered she could buy a one-year supply of her generic heart medication for $35 out of pocket instead of $120 using her health insurance.

Geoffrey Joyce, a USC economist who co-authored the study with Van Nuys. “The whole notion that you are paying more for the drug with insurance is just mind boggling, to think that they’re doing this and getting away with it.”

... the inflated copays could be explained by the role in the pharmaceutical supply chain played by pharmacy benefit managers, or PBMs.

... drug manufacturers will make payments to pharmacy benefit managers called “rebates.”

Pharmacy benefit managers usually take a cut of the rebate and then pass them on to the insurer. Insurers say they use use the money to lower costs for patients.

... 2013 ...overpayments averaged $7.69, totaling $135 million that year.

[order changed, bold mine]

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