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Nice Planet XII: It's Cruel to be Kind!

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Re: Nice Planet XII: It's Cruel to be Kind!

It's even worse than that.

You're going to see some class action lawsuits working there way through the system relating to insurance scams pulled by all the major players pertaining to drug purchases. The scam works this way.

You buy health insurance and you have a co-pay for when you go to fill a prescription. Let's say it's $10 or $20.

The pharmacy has a price they charge for the drug. It includes the cost to them, plus a fee.

Through companies, called Pharmacy Benefits Managers, the transaction is processed. The pharmacy is required by it's contracts to collect the entirety of the co-pay from the customer. The difference between the cost of the drug and the co-pay is then paid by the health insurer to the pharmacy.

Except, in a great many transactions the charge by the pharmacy is less than the co-pay. Customers don't realize it. After all, a bottle of pills certainly doesn't cost less than $10 or $20 does it?

The difference, referred to by various terms, including "clawback", is just kept by the health insurer, the Pharmacy Benefits Manager, or split between them. Keep in mind that most of the major Pharmacy Benefits Managers are owned by the insurance companies themselves.

Probably amounts to billions of dollars, and the outcome of these lawsuits, which are just gearing up, will be interesting to see.

For the PBM I work for (privately owned) I don't think that's true and people never pay more than the cost of the drug itself (that might include drug cost, fee, and tax but you get the idea). That might not be true for all of our clients though.
 
Who picked to go to college at Clarkson?

Me -> 44 years ago when Tuition, Room & Board were under $5,000 a year. It was a bit over $6K when I graduated in 1977. Cost of attendance is now over $60K.

Potsdam is a nice town/village. A bit isolated, but either you like it or you hate it. I thoroughly enjoyed my 5 years there and am looking forward to my 40th reunion next summer.
 
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