Clawbacks: Hidden Costs Of Copay

DECATUR, Ill. (WAND) – When you use insurance to pay for a drug prescription there is a good chance you use a copay to pay part of the cost. But what you may not know there is often an unseen middleman increasing costs for you and your pharmacist.
The middleman is known as a Pharmacy Benefit Manager, or PBM. PBM’s negotiate drug prices between drug makers, insurance providers and pharmacies. The PBM impacts you and your neighborhood pharmacist in a couple of ways through two types of transactions known as clawbacks. Copay clawbacks and DIR fees. Let’s look at copay clawbacks first:

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