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Valued Social Butterfly
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Re: Many Generic Rx's Cheaper Then the Copay

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This might also add a bit more info to your topic - just a different problem.

Yes, we do have a very complicated health care system where everybody wants to make a buck but sometimes they don't.

NPR Upshot 10/22/2015 - How Generic Drugs Can Cost Small Pharmacies Big Bucks

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Many Generic Rx's Cheaper Then the Copay

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Here is how it works and yes, Congress has been investigating the role that these "pharmacy benefits managers" play in the cost of drugs - brand and generics.

 

STAT NEWS 11/28/2016 - Rebates to Pharmacy Benefits Managers Are Contributing yo High Drg Prices

 

Yes, you can avoid this on especially some cheap generics if you shop around and don't use your insurance.  A lot of pharm achy chains use to have a list of their special generics and some may have given some for free.  But I think most all the chains now have or work with "pharmacy benefits managers".

 

Thought I had posted about this before but maybe it was on the Medicare and Insurance Board.  

 

IMO, this is just another way where a business has learned from the government with profits going into their pocket instead of back into a government program.  The VAHS (veterans health system) acts as their own "pharmacy benefits manager".  Few, if any, brand name meds with a generic alternative goes on their formulary and if there is more than one generic equivalent, the manufacturer that gives the best price or the best rebate goes on the formulary.  These may change from time to time based on the competitive nature of the manufacturer because the VA considers all generic forms of a med to be equivalent to the brand.

 

Same is true of Medicaid to a certain extent - any rebate on a med goes to the states for this program of Medicaid pharmacy benefits, that's the law.

 

These  private  pharmacy benefits managers don't just work with Medicare Plan D insurers.  They work with these insurance companies on all kinds of plans which have pharmacy benefits like group plans and even individual plans.    So you can see how picking up a bit of money here and there on each Rx gives them a lucrative business.  However they still have to be good at what they do in getting good prices for the insurer and develop these formularies based on these negotiations.

* * * * It's Always Something . . . Roseanne Roseannadanna
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Treasured Social Butterfly
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Re: Many Generic Rx's Cheaper Then the Copay

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Don;t we have one of our highly esteemed and prolific Forum Members who is a - Benefits Manager?

 

Maybe she could she some more light on this issue

 

 

( " China if You're Listening - Get Trumps Tax Returns " )

" )
" - Anonymous

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Many Generic Rx's Cheaper Then the Copay

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Eric Pusey has to bite his tongue when customers at his pharmacy cough up co-payments far higher than the cost of their low-cost generic drugs, thinking their insurance is getting them a good deal.

 

Pusey’s contracts with drug-benefit managers at his Medicap Pharmacy in Olyphant, Pennsylvania, bar him from volunteering the fact that for many cheap, generic medicines, co-pays sometimes are more expensive than if patients simply pay out of pocket and bypass insurance. The extra money -- what the industry calls a clawback -- ends up with the benefit companies. Pusey tells customers only if they ask.

 

“Some of them get fired up,” he said. “Some of them get angry at the whole system. Some of them don’t even believe that what we’re telling them is accurate.”

Prescription Rip Off.png

 

 

 

Clawbacks, which can be as little as $2 a prescription or as much as $30, may boost profits by hundreds of millions for benefit managers and have prompted at least 16 lawsuits since October.

 

The legal cases as well dozens of receipts obtained by Bloomberg and interviews with more than a dozen pharmacists and industry consultants show the growing importance of the clawbacks.

“It’s like crack cocaine,” said Susan Hayes, a consultant with Pharmacy Outcomes Specialists in Lake Zurich, Illinois. “They just can’t get enough.”

 

Source - https://www.bloomberg.com/news/articles/2017-02-24/sworn-to-secrecy-drugstores-stay-silent-as-custom...

 

 

( " China if You're Listening - Get Trumps Tax Returns " )

" )
" - Anonymous

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