File under “HOLY %#&@!”: Your Rx copay might be more than the cost of the meds

Published May 5, 2016

It’s this simple: pharmacy benefits managers — companies that handle the medication angle for health insurance companies — might require your pharmacy to collect a larger copay for a medication than the meds actually cost, and then pocket the difference. (Here’s a story on the practice.)

In other words, you would pay less if you didn’t use your insurance to “pay” for your prescription.

A med might cost $10. The pharmacist tacks on $1 for her fee. But the PBM says, “The patient’s copay is $50.” So you pay $50 and the PBM pockets $39 of it. Yes, for reals. Yes, often. You would be better off just paying $11 out of pocket, but then how would Express Scripts or Caremark or Optum or whatever other PBM make its money?

So ask your pharmacist, “How much would this medication cost without using insurance?” You might be surprised.

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