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Before paying drug copay, ask cash price

Written by Diane Archer

A new JAMA research letter reports that people are paying drug copays that are higher than the drug’s cash price more than 20 percent of the time. So, before paying the drug copay, ask the drug’s cash price. You may save yourself some money.

While copays should represent a portion of a drug’s costs, there is nothing in the law that requires pharmacy benefit managers or insurers to set the copay below the drug’s cost. So, they are requiring people to pay copays that can far exceed a drug’s cost. And, they are literally gagging the pharmacist from disclosing to you that you can save money on the drug if you do not use your insurance.

The solution is simple. Congress should step in and require insurers to charge copays that are no higher than the drug’s cash price. Moreover, Congress should require that pharmacists disclose to patients whenever a drug costs less than a copay. And, finally, Congress should require that insurers include members’ out-of-pocket cost for any drug purchased on formulary in the members’ total out-of-pocket costs, if the payment is for less than the copay amount.

There should be a way for people to expose insurers that are charging them copays that are more than the cost of the drug. And, anyone in one of these insurers’ plans should have the right to leave their health plan and transfer to a different insurer.

The research reveals that in 2013, overall, people overpaid for their drugs 23 percent of the time; 28 percent of the time for generic drugs specifically. People’s overpayments tended to be for generic drugs. And the overpayments averaged $7.69. While overpayments are less common for brand-name drugs, the amount of the overpayments tends to be larger, averaging $13.46.

Not surprisingly, 12 of the 20 most commonly prescribed drugs involved overpayments one-third of the time. The researchers question whether higher costs affect medication adherence and have a negative effect on health outcomes for people who cannot afford them.

Note that the researchers were not able to analyze more recent data. Shockingly, it is proprietary. You have to wonder what else the insurers and pharmacy benefit managers are hiding. You also have to wonder why Congress does not require the full disclosure of this information for the public good. After all, taxpayers and Medicare are paying these bills.

You should always ask the pharmacist about your drug’s cash price before paying the copay. The pharmacist must tell you if asked, and you could save a lot of money. If you have Medicare, you should know that if you go to an in-network pharmacy and pay a cash price lower than the copay, you can still submit the charge to your health plan. It will be counted towards your out-of-pocket expenses that put you in or get you out of the Part D donut hole.

If you are struggling to pay for your drugs, you might consider buying your drugs online or abroad, as millions of Americans are now doing.

And, if you want Congress to rein in drug prices, please sign this petition.

Here’s more from Just Care:

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