Americans may be surprised to learn that they could be paying more for their medications with their insurance copay instead of the cash price available to those without insurance. A study published last week found that Pharmacy Benefit Managers (PBMs) undermine claims that negotiated “rebates” with pharmaceutical companies are passed on to consumers. This follows a federal lawsuit filed over the summer after a California woman paid a $164 copay on a medication that can be purchased for $92 from the same pharmacy by anyone not using insurance. This practice is known as “clawback” and is instituted by PBMs who then receive the excess payments from the pharmacy.

Pharmacy Benefit Managers are being found to frequently charge a copay that exceeds a medication’s cash price for generic drugs. Moreover, pharmacists around the country are not allowed to disclose the price discrepancy to patients due to “gag clauses” in their contracts that forbid them

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NeedyMeds is celebrating twenty years since starting as a website for those seeking assistance with the high-costs of prescription medications. In 1997, Richard Sagall, MD, and Libby Overly, MSW, MEd, both realized a need for a centralized resource for information on pharmaceutical Patient Assistance Programs (PAPs). Over our first ten years, we gained 501(3)(c) non-profit status, introduced our PAPTracker software for advocates helping patients with PAP applications, and started our first newsletter Patient Advocate News (now known as Patient Assistance News; aka PAN).

In 2007, we began to expand the website from more than just Patient Assistance Programs to include government programs and other application assistance providers. The following year we grew to include databases of free/low-cost/sliding-scale clinics, coupons for medications, and other organizations that provide diagnosis-based assistance. The NeedyMeds Drug Discount Card started in 2009, saving users $560,000 in its first year nationwide. To date, the NeedyMeds Drug Discount

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Over 7 million previously uninsured Americans gained health coverage in 2015 as a result of the Affordable Care Act (ACA, aka ObamaCare). In a previous blog post, we showed the impact the ACA had since its full expansion in 2014.   Since then, the uninsured rate has dropped to single-digits with 9.1% Americans remaining uncovered by insurance, a decline of 2.4% since last year.

The Affordable Care Act has been criticized by Republicans and has led to multiple attempts to repeal the health care law or states refusing to expand Medicaid to help the poorest uninsured Americans.  States that have expanded Medicaid are seeing uninsured rates for adults 18-64 years of age around 9.8% compared to 17.5% for non-expansion states. Data from the Center for Disease Control and Prevention shows that 16.2 million fewer Americans are uninsured since the end of 2013.

NeedyMeds’ mission is to help those facing the high costs of health care, no matter what comes of the ACA. For those unable to afford their medications, NeedyMeds has an extensive database of Patient

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It is no secret that drug prices continue to be a problem in the United States. In a previous blog post, we discussed the environment in which skyrocketing drug prices are allowed to take off.  It has continued to be an important subject to Americans and the ongoing presidential campaigns.  The growing issue of medications costs is punctuated with head-spinning facts such as drugs that are $1,000 per pill in the US costing as little as $4 in India, or the life-expectancy is higher in Costa Rica than the United States despite higher income and amount spent on healthcare by Americans.  Some insurance companies are beginning to fight back against pharmaceutical companies pricing by dropping expensive drugs from their covered medications.

The strategy to drop expensive drugs from their formularies was established two years ago by Express Scripts, the largest pharmacy benefit manager in the US, when they announced they would no longer pay for 48 brand-name medications.  This was a result of many medicines raising over 20% in price over the previous year, so Express Scripts stopped paying for them in 2014 and moved their patients

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We are almost to 2016, and the high costs of prescriptions are still a huge problem for millions of Americans.  Despite laws like the Affordable Care Act (ACA), drug prices continue to vary and rise in ways that are often too much for patients to navigate.  A recent poll found that a third of those currently taking a medication experienced a spike in price in the past year. Consumer Reports was able to uncover a lot of information with a national price scan of five common generic drugs. With their findings in mind, there are tips one can follow to get lower prices and better deals on needed medication.

=&0=&  Even pharmacies within a few miles of each other can vary widely in price, sometimes by hundreds of dollars.  Furthermore, chain drugstores consistently charged the most among the medications and locations polled. Independent and local mom-and-pop pharmacies were found to have bargains on prescriptions, and sometimes are flexible to match or beat competitor prices. =&1=&  Many chain stores offer common generics at prices as low as $4-$15 for a 30- to 90- day supply when people pay out of pocket.  NeedyMeds has a database of locations and medications available through these discount programs. Sometimes pharmacists will insist you must use your health insurance, even it the price is higher than the cash price or the price with the NeedyMeds drug discount card. They are wrong – you never have to use your health insurance if you can get a better price not using it. =&2=&  For drugs you will be taking long term, getting enough medicine to last three months as opposed to one can be cheaper.  We mentioned the discount programs available above, and for those using insurance it would equate to only one copay instead of three. =&3=&  It may seem awkward or something better used at a car dealership, but Consumer Reports found that pharmacists either have some flexibility when asked or are able to find a coupon or card that can bring down the price, or offer one of the discount programs they may have available for those not using insurance. =&4=& Read more