In the spirit of nothing ventured nothing gained, activate your healthcare consumer mindset and try this the next time you have a prescription filled:
1. Fill the prescription.
2. Determine the amount of your copay for that prescription.
3. Simply ask, “What would this cost me if I paid for it out of my pocket instead of using my insurance coverage?”
4. Do the math and go the cheapest route.
It seems counter-intuitive, but it may be that the medicine actually costs less than the amount of your copay. At least part of the time.
Med City News reports that according to a recent study conducted by Dr. Karen Van Nuys and her colleagues at the University of Southern California Schaeffer Center for Health Policy and Economics, “…customers overpaid for their prescriptions 23 percent of the time, with an average overpayment of $7.69 on those transactions.”
How is this possible?
It has to do with “claw backs” executed by pharmacy benefits managers (middlemen like Express Scripts, CVS Caremark and OptumRx to name a few.) Again according to the Med City News article, here’s how it works: “After taking your insurance card, your pharmacist says you owe a $10 copay, which you pay, assuming that the drug costs more than $10 and your insurance is covering the rest. But unbeknownst to you, the drug actually cost only $7, and the PBM (pharmacy benefits managers) claws back the extra $3. Had you paid out-of-pocket, you would have gotten a better deal.”
It may be that your pharmacist will refuse to give you the information you seek. They are not being dishonest or rude – they may be prohibited from answering your question by “gag clauses” embedded in some insurance plans. That’s outrageous. In fact, 6 states have enacted laws to remove these “gag clauses” from insurance plans and 22 other states have similar legislation in process.
The bottom line: Ask the question. Nothing ventured nothing gained.
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