Monday, December 11, 2017

Prescription Drugs May Cost More With Insurance Than Without It

There are a lot of bad faith actors, on the PBM sell-side, engaged in concealing the truth. Employers, their brokers and advisors, must be fully engaged to uncover said truth. Full engagement requires a maintenance period which extends for an indeterminate period of time far beyond renewals and reading standard reports. If you read my blog, follow me on LinkedIn or done business with me you know I intend to help.

Reference Pricing for Rx's (Click to Enlarge)
Consequently, this help comes at a price. It makes me unpopular in the eyes of just about everyone except the commercial payers who benefit from the information I share. To this I say so what...right is right, wrong is wrong. It is stories like the one below which tighten the knot in the pit of my stomach.

This article was written through collaboration between The New York Times and ProPublica, the independent, nonprofit investigative journalism organization.

Having health insurance is supposed to save you money on your prescriptions. But increasingly, consumers are finding that isn’t the case.

Patrik Swanljung found this out when he went to fill a prescription for a generic cholesterol drug. In May, Mr. Swanljung handed his Medicare prescription card to the pharmacist at his local Walgreens and was told that he owed $83.94 for a three-month supply.

Alarmed at that price, Mr. Swanljung went online and found Blink Health, a start-up, offering the same drug — generic Crestor — for $45.89. It had struck a better deal than did his insurer, UnitedHealthcare. “It’s completely ridiculous,” said Mr. Swanljung, 72, who lives in Anacortes, Wash.

Tyrone's Comment:  That Blink Health struck a better deal is doubtful. Most likely, UHC struck a better deal but tacked on a huge mark-up for itself (it did not pass back all the savings it negotiated). Because the mark-up is hidden in the plan sponsor's final [ingredient] cost, this is the reason for the higher cost with insurance.

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