Some pharmacists barred from helping patients save money

Right now, you could be paying less for your prescription drugs, but there's a good chance your pharmacist isn't allowed to tell you about it. Sometimes, the cheaper way to go, means not using your health insurance. It’s because of a practice referred to as pharmacy clawbacks.

David Lundahl is one of many people who are confused when they pay for prescription drugs. He says, “It is frustrating when you're on one drug for your kid and you have to go off of it because the price changes and it's unaffordable.”

Lundahl says, “I don’t understand why I'm paying one price for one drug, while the same drug on another plan is what; two, three times the amount. It's very confusing.”

Most drug stores have a pharmacy benefit manager, or a PBM, to negotiate with insurance companies and set prices.

Action News Jax spoke with the owner of a local pharmacy who says, “They're kind of like a middle man. They get a rebate and give part of that back to the insurance companies.

Action News Jax agreed to hide his identity so he could speak freely about these practices.

He says, “The way things work with a big chains, is that they take whatever the copay is. Let’s say you had a $10 co-pay for generic drugs, the chain would charge you the $10 dollars. The price may be $4 if you walk up, but that's just how the contracts are written.”

That’s especially true for generic drugs, which often have lower prices than co-pays.

Not only are customers paying more than they should for some medications, contracts may prohibit pharmacists from telling you about possible savings if you pay in cash. It’s because insurers don't want pharmacies undercutting the deal, which takes money away from them.

Jo Bryan, another prescription drug customer says, “It's crazy, they're hiding facts.”

Bryan is a medical social worker. She’s intimately familiar with the practice because it’s her job to help people save money on their medical costs.

She says, “I hear my clients come back and having to pay $120 out-of-pocket and they have prescription Rx coverage and that's crazy.”

Pharmacists who break the rules, and tell customers about the secret savings, face losing their PBM contracts or their jobs.

The local pharmacist who spoke with us says, “If they weren't working within the protocols that were setup by the corporate office, yes I think that could happen.”

In other cases, the pharmacist behind the counter may also be in the dark about the savings.

He says, “They don't even know what the drug costs quite frequently, that's controlled by their corporate office.”

The take-away for consumers: Ask your pharmacy for its cash price and consider shopping around. Especially if you have a high co-pay or were prescribed a generic drug. You also more likely to find savings in smaller independent pharmacies.

“Look for a well-established pharmacy, an independent pharmacy because they have more leeway, you're usually talking to the owner, instead of a corporate policy already set”, the pharmacist says.

Also consider downloading one of many prescription drug apps on your phone. One of the biggest is called Good RX. It tracks prescription drug prices at local pharmacies and offers coupons to save you money.

Cox Media Group