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When a person goes into a pharmacy to pick up their prescription, they expect that only having to pay the required insurance co-pay is actually a good deal. Otherwise, what's the point of prescription coverage? But what if instead of a co-pay, you were being charged an "over-pay"?
A recent federal lawsuit filed by a San Francisco man against Walgreens in Northern District Court of Illinois alleges that insured customers are actually being charged more for their medications than those who don't use insurance. In fact, it is alleged that insurance co-pays can be significantly higher than the cash price of the same medication for a person without prescription coverage.
The Alleged Conspiracy
The lawsuit alleges that Walgreens was in cahoots with PBMs, or pharmacy benefit managers, such as ExpressScripts, OptumRx, and MedImpact. Basically, it's alleged that Walgreens and the PBMs would negotiate prices on meds that could be higher than cost of the meds without insurance and more than the total co-pay. Then, the pharmacy gets a higher price, and the PBM gets a "clawback" or portion of your co-pay.
Making matters worse, consumers are not informed of the fact that the cash price of their prescription would have been cheaper than using their insurance. This is due to the alleged deception that PBMs' consumers are led to believe that a co-pay represents a portion of the actual cost, hence the "co" before the "pay."
Are You a Class Member?
Clearly, this problem runs deep. The lawsuit seeks to represent all individuals who have had to pay more for their prescriptions than they should have due to the allegedly illicit agreement between Walgreens and several PBMs. But there are some major legal hurdles still to clear before anything takes shape.
While you may not know whether you were made to overpay in the past without some potentially challenging investigative work, you might be able to protect yourself in the future. If you have a PBM, the next time you go to get your prescription filled at a pharmacy, it might not be a bad idea to ask about the uninsured, cash price.