When health insurers agree to cover specific brand name drugs, they typically negotiate big discounts from pharmaceutical companies. Most insurers then pocket those discounts instead of passing them through to enrollees taking the drugs. The companies do that by basing the co-pays they charge on the list prices of drugs rather than the discounted prices.
An analysis of pharmaceutical company data published yesterday shows how much this is costing health plan members. In 2018, five of the largest drug makers provided discounts averaging 50% to insurers and pharmacy benefit managers (who are retained by insurers to negotiate on their behalf with drug makers).
What this means is that if you’re insured by a health plan that doesn’t pass along the discounts and you get charged a percentage co-pay or haven’t yet met your deductible, you’ll be forced to pay double the actual cost.
One of the biggest culprits is Blue Cross Blue Shield. Two other large insurers, Aetna and UnitedHealthcare, decided recently in response to the drug affordability crisis to pass along the discounts. But not Blue Cross Blue Shield insurers. With the sole exception of BCBS of North Carolina, they continue to exclude the discounts when calculating member cost sharing.
If Blue Cross Blue Shield insurers stopped screwing their enrollees out of those discounts, as this petition demands, a lot of people would see their prescription drug costs cut in half.