Here’s a little information regarding the so called “clawback” and how it affects the values of prescriptions. I had always wondered if something like this occurred in the industry, but I had no proof and had not read anything until now. In short, Pharmacy Benefit Managers (PBMs) negotiate copay prices for insurers that are often higher than the cash price paid by uninsured patients. Lots of states have previously passed rules banning claw-backs, but now a team of bipartisan U.S. senators have actually introduced a bill that would ban PBM-negotiated agreements nationwide.
American’s already pay a much higher prices for their medications compared to most other nations. A recent study by the University of Chicago discovered 32% of People in America didn’t obtain a prescription or took lower than the recommended dosage as a result of price. Pharmacists apparently feel complicit in cost gouging, and are also often not allowed to supply information that may save you some hard earned cash. Nonetheless, if a consumer asks the pharmacist for a reduced cost option most have been permitted to provide one under most pharmacies in house rules. Being mindful of this, it is usually smart to ask your pharmacist, “Is that the best price I can get for my medicine?” to ensure you’re not becoming a victim of the claw-back.
In the richest country in the world people to not need to be bothered about being cheated or compromising their health as a result of shortage in finances. For people without any prescription coverage or people who choose not to utilize it in order to avoid claw-backs, the MedCard Drug Discount Card saves 15-90% of the cash price for medication. For those who have incomes below 300% of the poverty level we have a list of Patient Assistance programs (PAPs) that offer prescriptions for low or zero cost. Simply login to your membership and complete the PAP application found in your member benefits area of the website. If you are on Medicare you may want to look into the Low Income Subsidy Program. Just go to the Social Security website and complete your application online.