Prescription Drugs May Cost More With Insurance Than Without It<br />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,<br />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.<br />A spokesman for UnitedHealthcare, Mr. Swanljung’s insurer, noted<br />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.<br />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,<br />but that’s not necessarily true for some generic drugs.<br />Behind the seemingly simple act of buying a bottle of pills, a host of players — drug companies, pharmacies, insurers<br />and pharmacy benefit managers — are taking a cut of the profits, even as consumers are left to fend for themselves, critics say.<br />In one case, a customer whose plan was managed by CVS Caremark, the drug benefit manager, would have had to pay more<br />for a drug through her plan at a CVS than what she ended up paying at the same store, with a coupon from GoodRx.<br />Further compounding confusion for consumers, some insurers require a set co-payment for each prescription<br />— say, $15 or $20 — even when the insurer reimburses the pharmacy at a much cheaper rate.<br />Alarmed at that price, Mr. Swanljung went online and found Blink Health, a start-up, offering the same drug — generic Crestor — for $45.89.
