1/30/2018 by Share Your Story

PBM: Pharmacy Benefit Managers forbid pharmacists from telling patients how to save money

Pharmacy Benefit Managers forbid pharmacists from telling you about ways to lower the price you pay for your prescriptions.


There’s a secret you should know about that could help lower the price you pay for your prescriptions when you pick them up at the pharmacy. The problem is pharmacists are forbidden from telling you about it. But we can.

It turns out you might pay less for your medicine if you didn’t use your insurance!! Sound strange? It’s actually true.

We’ve been telling you about Pharmacy Benefit Managers (PBMs). Insurers use them to negotiate deep discounts and rebates from drug manufacturers. They then tell insurers which drugs to cover on their plans. They also tell pharmacists how much to charge you.

But one of the problems is, you’re charged on the list price and not the discounted price. Guess who keeps the difference—the PBMs. So, they set the price you pay and take the difference, even though they already made money when they negotiated the discount from the drug manufacturer in the first place. It’s simply wrong. Insurance is supposed to help people afford their medications.

Patients everywhere are entitled to those savings.

What can you do about it? Two things:

First, you should always ask your pharmacist to check to see if it would be cheaper for you to pay without going through your insurance.

The reason your pharmacist can’t automatically tell you this information is because the contract they sign with the PBMs includes a gag order. They aren’t allowed to tell you this.

The second thing you can do is get involved. As we mentioned last week, some states have passed laws banning PBM gag orders. Several other states have legislation in the works. We’re getting involved but we need your help.

Click here to help us rectify this and protect patients everywhere to ensure we’re not paying more than we need to for our prescriptions.


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