Clawbacks & Hidden Fees: Are you paying too much for your prescriptions?

Do you pay a co-pay for your prescriptions? You could be overpaying for your prescriptions and giving Pharmacy Benefit Managers (“PBMs”)—insurance industry middlemen that most people have never even heard of—money to line their pockets! PBMs are using a “clawback” scheme to make more money off of consumers. You might think you are saving money or that your health plan is actually providing you a benefit by only paying your co-pay for your prescriptions, but in reality your co-pay might be higher than the actual cost of the drug. So who gets the extra money you are spending while your health plan pays nothing? The PBMs are “clawing back” the difference from your pharmacy to make more money for themselves.

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Hidden fees – Are you paying hidden fees for drugs that are not covered under Medicare Part D?

If you have a Medicare Part D plan with Humana, you may be paying an extra hidden fee for drugs that are not covered by your plan. When you fill a prescription for a non-covered drug, this is what happens: instead of rejecting your prescription or alerting the pharmacist that there may be an alternative covered drug, Humana allows the non-covered prescription to be purchased, but charges a hidden fee for every transaction. For example, if you filled a $15 prescription for cough syrup that is not covered under your Medicare Part D plan, Humana still allows you to fill your prescription but adds a hidden $5 fee to your “co-pay” charging you $20 instead of $15.

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