Some medications might be cheaper without insurance

RALEIGH, N.C. (WNCN) – Insurance plans have been providing discounts on prescriptions for decades through the use of co-pays, but nowadays, using your insurance to pay for your prescription may not be the best way to save money.

You’ve just filled a prescription and you’re thinking “my insurance co-pay gave me a good deal this.” But in some cases you can get a better by avoiding the use of your health insurance.

Before you take your next trip to the pharmacy and shell out cash for the co-pays, check the cash prices of area pharmacies through comparison websites like GoodRX.com.

You might find significant savings. Here’s an example.

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In a Philadelphia pharmacy, CBS News found the same seven drugs that cost nearly $160 in co-pays are available for just $62 cash – without insurance.

“It’s shocking, It’s outrageous. Why do you have insurance?,” says pharmacy customer Marc Falkowitz.

It turns out, pharmacies can sometimes offer a lower cash price if they don’t accept the insurance co-pay— most of which the local pharmacy never sees.

“It’s what we call a clawback,” says pharmacist Tom D’Angelo.

He explained to CBS news how a clawback works:

Let’s say the pharmacy gets a $45 co-pay fee. It gets to keep $1.62 of that co-pay. D’Angelo told CBS News “other $43.38 comes out of our check from the PBM.”

A PBM or Pharmacy Benefit Manager negotiates rates between pharmacies and insurance companies.

That’s because the insurance companies don’t want pharmacies undercutting the deals they have with drug makers so their contracts bar pharmacists from actively offering a cash sales for drugs.

Lawsuits are challenging clawbacks and some states have outlawed them.

For some consumers, not using insurance for prescriptions can sometimes make sense.

“They say they cover these things, but it’s in your best interest not to you use it,” says Falkowitz.

The bottom line in all this, you need to ask your pharmacy for its cash price and consider shopping around. You might be surprised how much of your money you’ll save.

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