Consumers are often shocked to discover they can sometimes get better prices on drugs than their own insurers. Although there are no nationwide figures to track how often consumers could have gotten a better deal on their own, one industry expert estimates that up to 10% of drug transactions involve such situations. If true nationwide, that figure could total as many 400 million prescriptions a year. The system has become so complex that "there's no chance that a consumer can figure it out without help," says the expert, Michael Rea, chief executive of Rx Savings Solutions. PBMs often do negotiate better prices for consumers, particularly for brand-name medications, Rea says, but that is not necessarily true for some generic drugs. Insurers' clients are frequently employers overseeing large numbers of workers, and the companies are focused on overall costs. So when insurers seek deals for generic drugs, they do so in batches, reaching agreements for groups of different drugs rather than getting the lowest price on every drug. As a result of these complicated layers of private negotiation, different insurers end up paying different prices for individual drugs. Several independent pharmacists say there might be safety issues if consumers buy drugs at different pharmacies. If those prescriptions are filled without an insurance card, pharmacy systems may not catch dangerous drug interactions. 'That, to me, is a recipe for disaster," says Craig Seither, who owns Fort Thomas Drug Center in Fort Thomas, KY.
Prescription drugs may cost more with insurance than without it