Drug copays are sometimes higher than out-of-pocket costs

As the debate around rising drug prices heightens, pharmacy benefit managers (PBMs) are taking on more scrutiny over copays that are sometimes higher than buying the drug out of pocket.

According to a recent study, insurance copays are higher than the cost of the drug about 25 percent of the time, PBS reported. Many patients don’t know that they can save money by buying a prescription drug without their insurance. And the high prices under copays for some drugs thrusts PBMs, which negotiate prices with drug companies, back into the spotlight.

“You have insurance because your belief is, you’re paying premiums, so when you need care, a large fraction of that cost is going to be borne by your insurance company,” Geoffrey Joyce, a USC economist and co-author of the study, told PBS. “The whole notion that you are paying more for the drug with insurance is just mind boggling, to think that they’re doing this and getting away with it.”

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