Co-pay Clawback???

CVS I’m thinking that it is no wonder that patients are getting increasingly confused, and ticked off, about drug pricing. We talked recently about a patient who got quite befuddled as to why his insurance company would cover the cost of a branded product, but not the much lower cost of generic equivalents. Recall that the reason for this weird state of affairs was a rebate deal that had been struck between the pharmacy and the drug company. Today is a variation on the same theme. With a twist. Some California customers have discovered that their co-pay for some drugs was higher than the cash price of the medicine. And where did the extra money wind up? It allegedly got clawed back, according to lawsuits filed against CVS and other chain pharmacies, into an unholy profitability collaboration between the drug stores and PBM’s. And this is not about nickels and dimes. In one case, the patient was charge a co-pay of $166 for a drug that could have been purchased for only $92 in cash. Bottom Line. Want to get in the way of patient adherence with their drug therapies? Here is what you do. You get patients so confused and angry about drug pricing that they never want to show their face at a prescription counter again. Yup, that’ll do it!

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