In the News
FOX 8: Drug consumers seek relief as PBM's make money hand over fist
A few taps on Carol Shoemaker's phone saves her hundreds of dollars in the pharmacy.
"It's crazy, it's distressing," Shoemaker says, "the amount of money you pay for insurance. I pay between $600 and $700 a month for a premium because I'm a single person, I don't have a company, you know, getting any discounts with big group insurance policies. So, it's very distressing - you're already spending a ton of money on insurance, but you still have to pay for, you know, all of the extra."
Shoemaker almost paid a lot more for one drug; it cost $613 with her insurance. But instead of using that insurance, Shoemaker logged on to one of those cost-saving prescription apps - in this case, GoodRx - and paid just $272 for the medication.
"For me, that's just too much money to be throwing out the window," Shoemaker tells us.
She shows us a printout - her family's medications, with the savings she found online. Shoemaker says those annual savings add up. "It could be a thousand bucks," she says.
And last year she could have saved even more: She used her insurance for a $277 cream, but only later found out she could have paid just $11.72 via an app.
"My husband's going to kill me for that," she jokes, noting the $260 in missed savings would have bought "a nice pair of shoes."
Pharmacy benefit managers, or PBM's, control these costs for your prescription drugs.
"The PBM's in everyone's pocket," warns Doug Hoey, who heads National Community Pharmacists Association. "I mean that literally and figuratively because, in every wallet or purse, that prescription drug card that people carry around, somewhere in the fine print, it'll usually say the name of the PBM, the pharmacy benefits manager."
The three biggest PBM's are CVS/Caremark, Express Scripts and Optum, which is owned by United Healthcare.
"They're huge," Hoey says. "They're probably companies you've never heard of. But they're bigger than the drug manufacturers."
Here at WVUE/FOX 8, Caremark manages our prescription medication. We compared some of the prices our colleagues were being charged.
We found one antibiotic, Ciprofloxacin that costs $15 through our insurance at the Walmart pharmacy. Using GoodRx, the same medication can be bought for just $4. And we found similar savings on an arthritis drug, Meloxicam.
"It doesn't make sense," Hoey says. "It's counterintuitive. I mean, you stroke a check each month to pay your premium and you expect that to give you some value. And the reality is that, in increasing numbers of cases, if you just did it the good old-fashioned way of paying cash, you might pay less for your prescription."
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