Insights on PBM practices

A New Orleans TV station dove into the murky practices of PBMs and clearly demonstrated how patients are being ripped off, PBM pockets being lined, and pharmacists muzzled.  WVUE FOX 8 News reporter Lee Lurik found that the nation’s largest insurance carrier, United HealthCare, makes customers pay a premium on some prescription drugs, charging them more than the actual costs — clawing back money from the pharmacy and customer.

On May 16, Zurik reported that documents provided by multiple pharmacists show the pharmacy benefit manager for United HealthCare, OptumRx, frequently overcharges for medication.  He said that some pharmacists think the practice is most common with generic drugs and high deductible insurance plans.  OptumRx is owned by United HealthCare.

Consumers naturally assume their insurance is paying for part of the cost of the medication.  Most consumers don’t know about these middlemen called PBMs, like Optum or Catamaran, in the middle of the transaction.  And they manage hundreds of millions of dollars.

PBM Express Scripts is bigger than Walt Disney, McDonalds and Ely Lilly combined.

One pharmacist provided FOX 8 a prescription bought in the Medicare Part D program that may reveal another company clawing back money.  Aetna made the customer in this case pay a $50 copay on a depression medication — but the pharmacist said he would have sold it to the same customer without insurance for about $17.