PBS Newshour reported on the surprise one man felt after learning that paying cash for his wife’s prescription would have been far cheaper than running it through their insurance. Gretchen Liu suffered a transient ischemic attack while on a trip abroad. Once she returned home, her doctor prescribed telmisartan, a generic medication that helps to manage blood pressure. The couple paid $285 for a 90-day supply of the pills through Express Scripts, the pharmacy benefits manager (PBM) for their insurer, Anthem Medicare.
An extended international trip necessitated a refill before a 90-day supply was up, but Anthem refused to cover it. While shopping at Costco one day, Z. Ming Ma, Gretchen’s husband, asked how much the cash price would be at the pharmacy there and was told it would only cost him $40 for a 90-day supply. This is a classic example of how using your health insurance when you need to pick up a prescription will not always get you the best price.
In this case, both the insurer and the PBM blamed the other for the high price, but this situation is not unique. The PBS Newshour article referenced a study that PSM wrote about in April. An analysis of prescription data from 2013 showed that 23% of the claims involved a patient co-payment that exceeded the average reimbursement paid by the insurer by more than $2.00, with the average overpayment working out to be $7.69. While overpayments happened on 28% of generic drug purchases, they also occurred on 6% of brand-name drugs purchases.
So, how can you make sure that something like this never happens to you? The best thing you can do is talk to your pharmacist and specifically ask them if using your insurance will give you the lowest price. Many pharmacists have gag clauses that prevent them from bringing this topic up first, but once you bring it up, they can let you know about better options. Also, always check what the cash price is for your medications using both GoodRx.com and WellRx.com. Both of these websites have apps you can install on your smartphone so you can quickly check prices while you are on the go.