We are receiving information about a disturbing new trend involving potential price gouging by PBMs. PBMs may have been charging patients copayments for prescription drugs that exceed the actual cash price of the drug. PBMs later recoup from the Pharmacy the difference in value between the price of the drug and the higher copayment Patient lose by paying more than reasonably required. PBMs win.
PBMs, who serve as the middle man between a patient’s plan and pharmacies, dictate the price patients pay for medications. PBMs could set copay values that exceed a pharmacy’s cash price for the drug. Rather than notify the patient of the cash price less than the copayment, PBMs remain silent causing patients to pay the higher amount. PBMs then “clawback” the difference in price from the pharmacies.
To make matters worse, PBMs often hold pharmacies to “gag clauses” in their contracts with the PBM as a condition of the pharmacy’s participation in the PBM’s networks. These clauses prevent pharmacies from alerting patients to the price difference, unless the patient specially knows to ask.. If a pharmacy violates the “gag clause,” PBMs can terminate the pharmacy from the PBM’s networks, a consequence that frequently results in the pharmacy losing a majority of its business, or even having to close its doors.
Patients should not pay more than the cash price for their prescription. If you are a patient who has been charged a copay higher than the cash price (or you suspect that your PBM is charging the higher amount), contact Frier Levitt to speak to an attorney regarding whether you may serve as the Representative Plaintiff in a class action lawsuit.