Insurance Negotiatos Contributing to Rise in Insurance Costs

[Aargh]

A lady went to her pharmacist and was surprised to be charged $140 for her generic prescription - AFTER her insurance was applied. A friend told her to go back and ask what it would be if she DID NOT have insurance. It was under $70 WITHOUT insurance.

She had another prescription that was $126 through her insurance. It was $26 if she bought it WITHOUT using her insurance.

It turns out insurance companies have hired negotiators who negotiate with pharmaceuticals to establish the prices insurance companies pay for prescriptions. These negotiators seem to have negotiated the price UP instead of down.

You would think that insurance companies would negotiate the lowest possible price, which would put them at a competitive advantage over other insurers, but what they are actually doing seems to be going the opposite direction, which raises premium costs. Insurance carriers are required to spend 80% of their premiums on client services, so raising costs raises the amount they can keep. This goes completely contrary to the free market principles that are supposed to control health care costs.

http://www.kwch.com/content/news/FF12--Pharmacists-fed-up-with-middlemen-costing-you-money-413659253.html

[RoyalShock]

If that's the case, then the pharmacy should have it's windows shuttered. I would never step foot inside another store with a pharmacy who would do that to their customers.

Don't think for a minute that the pharmacy didn't know exactly what they were doing.

[SHOCKvalue]

I've heard of this before. I don't think it is new news, but it certainly doesn't change the ethics.

[Aargh]

If that's the case, then the pharmacy should have it's windows shuttered. I would never step foot inside another store with a pharmacy who would do that to their customers.

Don't think for a minute that the pharmacy didn't know exactly what they were doing.

Check the video report. Pharmacists aren't allowed to inform their clients of this practice. It seems that the client has to ask. Pharmacists seem to be leading the efforts to end the practice.

[WuDrWu]

I remember that happening to me over an antibiotic. However it was a bit different, they tried to charge me the $10 copay (I knew better) and I asked what it was without insurance and she told me $7.06.

That was my last time shopping in that store as well.

[jazztrane]

We just ran into this with a specialized (compounding pharmacy) Rx for my wife. $100/month, BCBS wouldn't cover it but would reimburse us $23/month if we sent it in to them after we paid the full amount. We just changed to Aetna, who won't cover it at all, but the pharmacy said if we just pay cash for a 90 day supply it would be $70/month.

At one point BCBS said they would not cover this Rx, but instead suggested she go on four others (anti-depressant, anti-anxiety, etc.) that would have cost us only about $30/month in co-pays, but cost insurance about $400/month. So don't cover $100/month but suggest we switch to something costing them $400/month, makes sense.