Secrecy rules gag drugstores as patients overpay

Eric Pusey has to bite his tongue when customers at his pharmacy cough up co-payments far higher than the cost of their low-cost generic drugs, thinking their insurance is getting them a good deal.

Pusey’s contracts with drug-benefit managers at his Medicap Pharmacy in Olyphant, Pa., bar him from volunteering the fact that for many cheap, generic medicines, co-pays sometimes are more expensive than if patients simply pay out of pocket and bypass insurance.

The legal cases as well as dozens of receipts obtained by Bloomberg and interviews with more than a dozen pharmacists and industry consultants show the growing importance of the clawbacks.

President Trump is promising to lower drug costs, saying the government should get better prices and the pharmaceutical industry is “getting away with murder.”

The Pharmaceutical Care Management Association, a benefits-manager trade group, says it expects greater scrutiny of its role in the price of medicine and wants to make its case “vocally and effectively.”

“Pharmacies should always charge our members the lowest amount outlined under their plan when filling prescriptions,” UnitedHealthcare spokesman Matthew Wiggin said in a statement.

“Patients should not have to pay more than a network drugstore’s submitted charges to the health plan,” Charles Cote, a spokesman for the Pharmaceutical Care Management Association, said in a statement.

The customers see that they go in, they are paying a $10 co-pay for amoxicillin, having no idea that the benefits manager and the pharmacy have agreed that the actual cost is less than a dollar, and they’re still paying the $10 co-pay.

On Feb. 10, a customer at an Ohio pharmacy paid a $15 co-pay for 40 milligrams of generic stomach medicine pantoprazole that the pharmacist bought for $2.05, according to receipts obtained by Bloomberg.