I’ve heard from several clients about recent pharmacy visits.

The details vary but the general theme is that if they use their health plan they pay more than if they pay cash. I wrote about that several months ago in Tip # 350. Please take a moment and review here.

I’ve since learned of something called “Claw Backs.”

Many health plans use Pharmacy Benefit Management companies to administer prescription claims. Apparently, in many cases the PBM’s negotiated rate for our medications is higher than the actual cost. If we as members pay that, the PBM recaptures the overcharge from the pharmacist, thus the “clawback.”

So, where does that money go and is it any wonder some pharmacists ask us to just pay cash for our prescriptions?  Google prescription clawbacks to learn more.

I’m not sure what to do about this but if something similar has happened to you, I’d like to hear from you. Armed with information, I can advocate on our behalf.

I think that’s what brokers are supposed to do!