Prescription Drugs May Cost More With Insurance Than Without It
Representatives for insurers and pharmacy benefit managers say cases like Mr. Swanljung’s are “outliers.” “There are three to four billion generic scripts written a year,
and in the vast majority of cases, they are going to get a better deal by using insurance,” said Mark Merritt, chief executive of the Pharmaceutical Care Management Association, which represents benefit managers.
A spokesman for UnitedHealthcare, Mr. Swanljung’s insurer, noted
that while Mr. Swanljung got a lower price for generic Crestor through Blink Health, he also takes four other prescriptions, for which he got a better deal by using his insurance.
Pharmacy benefit managers, the companies that deal with drug benefits on behalf of insurers, often do negotiate better prices for consumers, particularly for brand-name medications, Mr. Rea said,
but that’s not necessarily true for some generic drugs.
Behind the seemingly simple act of buying a bottle of pills, a host of players — drug companies, pharmacies, insurers
and pharmacy benefit managers — are taking a cut of the profits, even as consumers are left to fend for themselves, critics say.
Further compounding confusion for consumers, some insurers require a set co-payment for each prescription
— say, $15 or $20 — even when the insurer reimburses the pharmacy at a much cheaper rate.
In one case, a customer whose plan was managed by CVS Caremark, the drug benefit manager, would have had to pay more
for a drug through her plan at a CVS than what she ended up paying at the same store, with a coupon from GoodRx.
Alarmed at that price, Mr. Swanljung went online and found Blink Health, a start-up, offering the same drug — generic Crestor — for $45.89.