How Pharmacies, Drug Companies and PBMs are Stealing

Every time I write an Rx for someone I try to keep the cost in mind. I also scan goodrx.com and give the patient a coupon EVEN if they have insurance. Why? Read this article. The system is rigged and the insurance companies don’t help reduce the cost. They, and the PBMs, are double dipping (many times). A recent example that I had was $26 cash for a cortisone cream versus $259 if the insurance was used. The whole system is broken. Physicians need to be advocates for patients versus just mindlessly writing for a drug and rushing out of the room.

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  4 comments for “How Pharmacies, Drug Companies and PBMs are Stealing

  1. Charles Lipson
    August 16, 2017 at 11:44 am

    This week I was told by Costco that United Health part D will not cover the generic for Zetia. Their copay was $124. I then asked for the generic and was charged $45. Massachusetts has a law that says pharmacists must fill all prescriptions with generics when available. Yet, Costco assumed I wanted to pay the higher amount because i have insurance without asking. I think we need class action law suits here.

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  2. Randy
    August 13, 2017 at 9:49 am

    I tell patients they have to shop and compare pricing for meds like they would shop for anything else. I use GoodRx all the time and so far I have not seen any bias or shadiness from their site, and it’s a great resource.

    My take is that what the PBM’s are doing is technically legal, but unethical. Patients buy these polices with pharmacy benefits because they believe it will get them a better deal on meds. Instead the pharmacies and PBM’s use it as an opportunity to milk more profits from the patients.

    I also wonder what the responsibility of the individual pharmacists is on this, since they have a direct responsibility to the patient similar to the one we have as physicians. if a pharmacist knows there is a coupon available to get a med for $26, keeps it quiet and lets the patient pay $259, what does that say about their relationship? Often a patient will forego the meds since they can’t afford them, what does it say about a pharmacist that will let that happen while knowing there are affordable options for the patient?

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    • John Chamberlain
      August 13, 2017 at 10:20 am

      Just the other day, I went to pick up a scrip for my wife at Publix. The price given to my wife was $90. Good Rx had it for $33. When I showed the pharmacist that price, she said Publix doesn’t accept Good Rx pricing.

      I then said I would go somewhere that did, please cancel this Rx.

      She then said, but we have a similar pricing structure and can get that for you for $23.71!

      If I hadn’t persisted, it would have been $90! How many people would know to persist or would they just have paid the $90?

      Btw, this was on a self-pay prescription.

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  3. John Chamberlain
    August 13, 2017 at 8:41 am

    Thanks, Doug, for trying to make more people aware of this chicanery.

    The question is how many billions of dollars are being stolen in this fashion? The next question in my mind is in what other similar areas, say DME for instance, is this practice occurring?

    The more patients and physicians that are made aware of this practice, the sooner we can get it stopped.

    What great targets for the OIG, eh? Let’s stop this fraud.

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