PHILADELPHIA (CBSMiami) – Insurance co-pays are meant to give you a good deal on their prescription drugs.
But in some cases, a better deal can be found by simply not using your insurance at all.
For years, Mark Falkowitz made a monthly pharmacy trip to buy medication for his aunt. When he complained about the cost of the co-pays, the pharmacist told him about an alternative. He could check area pharmacies’ cash prices through comparison websites like goodrx.com.
Falkowitz did and found the same seven drugs that cost nearly $160 in co-pays were available for just $62 without insurance.
“It’s shocking, It’s outrageous. Why do you have insurance,” wondered Falkowitz.
Pharmacies can sometimes offer a lower cash price because they don’t always pocket the co-pay.
“It’s what we call a clawback,” said Tom D’Angelo with Pharmacist Americare Pharmaceutical Services Inc.
He said when pharmacy receives a co-pay for a prescription, they don’t get to keep all of it. In fact, most goes to the pharmacy benefit manager (PBM) which negotiates rates between pharmacies and insurance companies.
D’Angelo said the PBM doesn’t want pharmacies to undercut their deals so contracts bar pharmacists from actively offering a cash sale.
Lawsuits are challenging clawbacks and some states have outlawed them. Benefit managers insist pharmacists are empowered to charge the cash price if it’s lower.
So who is at fault?
“It’s gotta be the drug companies and the pharmacies,” said Falkowitz. “They say they cover these things but it’s in your best interest not to you use it. Good business for them. Bad for me.”
Pharmacists say you should pay special attention to the cash price if you’re buying generic drugs using a high-deductible insurance plan. Insurers point out those cash sales don’t count towards your deductible.