In a health care world in which, among other things, the government is now overpaying insurers offering Medicare Advantage plans $140 billion this year without seeming to blink, pharmaceutical companies are charging tens of thousands of dollars for some life-saving medicines with no government talk of across-the-board drug price negotiation, and hospital systems are dying because Medicare Advantage plans are not paying their bills, it’s refreshing to learn that pharmacies are fighting back against overcharges. Reuters reports that pharmacies are suing Express Scripts, a pharmacy benefits manager (PBM), in a class action for raising fees on them and reimbursing them at low rates.
Express Scripts is a company that rakes in billions in profits a year for Cigna from pharmaceutical company rebates it receives for putting high cost drugs on insurance company formularies–the prescription drugs your insurance covers–and steering patients to use them. No kidding. For example, you can read here about how pharmacy benefit managers (PBMs) are getting paid big bucks from Humira’s manufacturer to steer people away from its lower-cost competitors.
Because the pharmacy benefit managers, often in collaboration with your insurance company, are looking to maximize their profits, you could end up spending more if you get your drugs through your insurance company rather than through Costco mail-order, MarK Cuban’s Cost Plus Pharmacy or a coupon at your local pharmacy. This is true if you have a Medicare Part D prescription drug plan as well. Always check with Costco or another low-cost mail order pharmacy to save money; if that’s not an option, ask your pharmacist whether there’s a less costly option than using your insurance to cover your drugs; there often is.
Because the pharmacies have the will and the money to take on Express Scripts, they should be able to correct the problem and end the gouging. If only the government would step in on behalf of individuals to keep the pharmacy benefit managers from gouging us.
The complaint by four pharmaceutical companies accuses Express Scripts of collaborating with Prime Therapeutics to hike up reimbursement rates and fees.
Here’s more from Just Care:
