“Aetna Coventry [Medicare] Advantage plan telling us to charge a $100 copay on generic Ambien, which we could sell to the customer for $15. Also, telling us to charge $100 for generic opioid pain medicine when [the patient] could buy it in cash for $50-$70.”
“For the month of May in my pharmacy there were 277 instances of clawbacks. In the worst case the patient paid a $40 copay and $27.50 was taken back by the insurance company.”
The above quote was sent into a survey by the National Community Pharmacists Assoc (NCPA). Apparently some health insurance companies are charging pts the maximum copay for a particular tier.. even if the normal prices is less than the stated copay… and then they “claw back” the difference between the normal price and the copay from the pharmacy… sort of like a PREMIUM SURCHARGE to the pt if they use their medication benefit.
My suggestion to anyone always getting a flat dollar copay to start checking the price of their medication on a website like www.goodrx.com. I would also suggest that if you discover such SURCHARGES.. that you start filing complaints with the State Insurance Commissioner and/or or the Consumer Protection Agency.. normally part of the State’s Attorney General Office.
Filed under: General Problems
On Medicare, we are not allowed to use coupons or discounts. Is there a place, besides calling every pharmacy, to look up prices?