What is a Pharmacy Benefit Manager?
Watch this video and find out:
But this is all good, right? They're managing the whole process and lowering costs for everyone, right?
Hmmm... better watch this video too:
And this one:
So the next time you're at your neighborhood pharmacy and your medication isn't covered or is hugely expensive, DON'T get mad at the pharmacist or pharmacy technician.
Join CostCo. Or at least, check their cash-only price, on your generic, and remember you don't have to be a member to use their pharmacy. Downside: Costco pharmacy is one of the worst customer experiences you'll have in person. Mail order is excellent, once set up.
But. It's an independent check on prices. Costco generally doesn't play well with the PBM as a mail order pharmacy (that is, the PBM won't let them file insurance), but compared to the PBM pharmacy, Costco may be 3-10 time cheaper even without insurance. Real example: my PBM wants me to use their mailorder, or local pharmacy, for a common generic; their price is $40/month, $480/yr. Same generic filled locally at Costco is $9/month with the tier 3 PBM payment, or $14/month via Costco mail order (and no hassle with getting to store, etc).
Also consider the straight one-price generics vs your co-pay. I routinely refused to file insurance when doing so raised my cost. EG, $4 generic for cash, but file insurance and suddenly it's way more. This drove in-store pharmacies nuts (staff just didn't get it- essentially had to say "no insurance" to avoid the incessant arguments).
Some PBMs offer literally free Rxs to members. Take those; price shop everything else. You may save hundreds to thousands by simply doing a little homework. I did, still do.
The PBM racket means you have to work a bit. If it takes 4 hours to compare the $4 lists and look up your cash price at a place like Costco, and you save $800-1000 a year out of pocket simply by having your doc send scrips to 2 places, you just made $200+ an hour.
You won't drive the local pharmacist nuts, either- because you'll know what the pricing is, and either you'll be happy or you'll go elsewhere.
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