Insurance company prescription co-pay costs are not always cheaper than paying for medicine without your insurance card.
That’s because insurance companies, known as third-party benefit managers, are often inflating the price of your prescriptions. You may not even know it because the insurance companies have gagged pharmacists.
This is not a matter of name-brand versus generic, but an across-the-board price increase on many common pharmaceuticals. Insurance companies often tacked on an “administrative cost” as your pharmacy “benefit” manager.
It’s up to the consumer to ask “what’s your cash price?”
That’s the cost you can pay if you don’t use your insurance “benefit”. American’s are conditioned to believe their medical insurance carrier is getting you the lowest price, but experts say that’s not always true.
Norman Augustine of the National Academies of Science, Engineering and Medicine, who testified before the U.S. Senate, explains the prices.
“They had two drugs for me to choose from and asked me which one did I want? One was $86. The other was $5. And I said ‘what’s the difference?'” he asked, adding, “They said ‘they’re identical’. So I said, ‘I think I’ll go with the $5 drug’. So why couldn’t they make that decision for me? They’re not allowed to.”
District 1 Rep. Buddy Carter, R-Ga., is sponsoring a bill to eliminate the ban.
“This is something that there is no reason at all should exist,” Carter tells News 3 about a personal experience from a colleague. “Their co-payment was gonna be $1,300 and this was a committee member and so she asked. She had enough knowledge to inquire how much would it be if I paid cash? and it was $40.”
Carter’s bill cleared committee, next stop is the House floor.
But a version by Sen. Susan Margaret Collins, R-ME, is on a faster track — as it’s already approved by the Senate.
Collins talked about many examples of Americans shelling out more for prescription medicine because pharmacists are gagged by contracts initiated by insurance companies.
“For example, NBC did a piece that showed that a consumer who had a copay of $43 for a cholesterol drug would have only paid $19 if that consumer had only paid out of pocket,” she explained.
President Trump has said in the past that he agrees pharmacists should be allowed to tell their customers when there’s a better price on exactly the same name brand or generic drug.