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Posted on 19. April 2018

Are Your Prescriptions Cheaper Without Insurance?

By Dominick Spatafora

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The Neuropathy Action Foundation has been working on an issue since last summer, when an NBC Nightly News segment with Lester Holt aired titled "Prescriptions May Be Cheaper without Insurance." And, the practice may be harming neuropathy patients.

The story highlighted a practice occurring throughout the U.S. where a patient goes to their pharmacy to fill a prescription and is charged a copayment through their insurance that may be more than if the patient were to pay cash. When this happens, pharmacists are prohibited from disclosing the price discrepancy. The pharmacist is reimbursed at the normal rate, but is contractually obligated to send the overcharged money to the pharmacy benefit manager (PBM).

Here's an example: Sarah goes to the pharmacy to pick up her diabetic neuropathy medication. The medication would only cost $5 if she pays cash. However, Sarah paid a $20 insurance copay. The pharmacist is prohibited from telling Sarah that she would have saved $15 if she paid cash. And, who gets that $15 margin? You guessed it: the PBM. Several states like Arkansas, Arizona, California, Maryland, Minnesota and New York are currently pursuing legislation to address this. To learn more, here is a link to a Feb. 24 article in the New York Times titled "Why Your Pharmacist Can't Tell You That $20 Prescription Could Cost Only $8."


Dominick Spatafora is a multifocal motor neuropathy patient and president of the Neuropathy Action Foundation. He received a Bachelor of Science degree from Arizona State University, and he also holds a Master of Public Administration degree from The American University in Washington, D.C.

This article is printed with permission from Dominick Spatafora. The original can be read at neuropathyaction.org/about_naf/index.htm

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