Having health insurance means saving money on prescriptions, right? Not necessarily. A study published Tuesday in JAMA found insurance co-pays for generic drugs were actually higher than the cost of the drug 28% of the time. For name-brand drugs, it was 6%. Say your insurance has a $10 co-pay for prescription drugs; sometimes you're paying that $10 co-pay when the drug only costs $7, according to an example in the Los Angeles Times. Charging a co-pay higher than the cost of the drug is known as a "clawback." “This is money that patients could be saving if they knew about and could avoid the practice,” lead study author Karen Van Nuys tells Reuters. Co-author Geoffrey Joyce adds to the Times: "You're penalizing people for having insurance."
The study looked at 9.5 million claims for prescriptions in 2013. It found 2.2 million of those included clawbacks totaling $135 million. The average clawback was $7.69. The most frequent clawback was on zolpidem tartrate, which is generic Ambien. Twelve of the 20 most commonly prescribed drugs were cheaper than co-pays 33% of the time or more. To avoid clawbacks, health policy researcher Stacie Dusetzina says people should always ask pharmacists if it would be cheaper to pay directly for their prescriptions rather than using insurance. However, some some insurance plans bar pharmacists from telling patients when they could get their prescriptions cheaper by paying cash. (A new study found Tylenol and Advil work just as well as opioids.)
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