NUMBER 4 |A Drug Costs More With Insurance
In early 2018 Murray B. a 67-year-old computer software developer in Acton, Mass., was surprised to find that a prescription for generic Xanax cost almost $40 more with a Mediare Part D drug plan than without it if he shopped at the online pharmacy HealthWarehouse.com
WHY IT HAPPENS
Bob could be experiencing a “clawback.” That’s when companies called pharmacy benefit managers (PBMs), which act as go-betweens for drugmakers and pharmacies. set higher prices on meds than drugstores.
When asked to explain clawbacks, the Pharmaceutical Care Management Association, which represents PBMs, didn’t comment directly, saying only, “We support the patient paying the lowest price available at the pharmacy counter.”
Critics of the practice are more direct. “It borders on fraud.” says S. W. Schondelmeyer, a professor of pharmaceutical economics at the University of Minnesota.
He describes clawbacks as unnecessary, hidden charges that end up costing consumers.