Zurik Report: Part 2

 

Cassidy slams drug cost clawbacks, demands transparency

Written by: Lee Zurik, Chief Investigative Reporter
Contributor: Tom Wright, Investigative Producer
 
Link to Article.
 

METAIRIE, LA (WVUE) - Documents uncovered by FOX 8 News show real-life examples of patients going to the pharmacy and getting charged a premium on their medication.  We showed you several cases Wednesday night of customers paying more in copay for drugs than the drugs themselves actually cost.

Now one of the most powerful politicians in Washington wants to get our documents.

"Lee, give me copies of those,” says U.S. Senator Bill Cassidy of Louisiana. "That's [the information] we've been putting together as we intend to build support for what we're trying to do.”

Pharmacists we interviewed say they legally cannot tell the customer they're getting ripped off.  But we have examples of four healthcare providers, including a company linked to UnitedHealthcare, paying nothing toward some of their customers' drug costs. 

The insurance company labels it a copay. But in some cases only one person pays – you.

Senator Cassidy (R-Baton Rouge) is a physician and a member of the U.S. Senate Committee on Health, Education, Labor & Pensions.  He says that committee tackles the topic of drug pricing.

"It's an incredibly complicated topic,” Cassidy tells us.  "And there's not a silver bullet that's going to address it.  But when you have something like that, it just drives home the need to address it.  And that's what we're attempting to do.”

Cassidy says he's eager to get our information "Absolutely - everywhere I go, people are talking to us about drug costs,” he says.

Patients and customers should know more, Cassidy insists.

"We are building a case that we have to have this transparency of pricing,” he says.

None of these patients knew, even after paying a monthly insurance premium, more money was being taken from them when they went to the pharmacy.  Pharmacists call it a clawback - patients getting charged more than the cost of the drug, and that money being clawed back from the patient and pharmacy.

The senator agrees, these patients would be better off buying these medications without insurance - but they don't know that. 

"If you give them transparency, then they start to know it,” Cassidy tells us. ”It's not there right now. Until we have real-life examples… That explains so beautifully what I otherwise struggle to explain - this receipt is worth a thousand words.  Clawback for the person… they would have been better off paying without insurance.”

La. Insurance Commissioner Jim Donelon calls the clawback an additional fee or premium on customers - more money leaving people's hands, going to large companies to help pad their bottom line.

"The patient is subsidizing the entity which is supposed to be their advocate,” Cassidy notes. "Makes no sense whatsoever.  The patient's getting hammered.  We have to give the patient the power. We have to mandate that she knows what the insurance company knows and what everyone else knows.  As long as it's hidden from her, it's another person's game.”

Thursday, FOX 8 received statements from Optum, UnitedHealthcare's pharmacy benefits manager, in response to our request for comment on the apparent clawbacks:

“OptumRx’s pharmacy reimbursement program helps ensure the millions of people we serve have affordable access to the drugs they need by ensuring they pay the lowest price available to them for prescription drugs... Those recouped overpayments are returned to the health plan to reduce overall health plan costs."

A company spokesman also told us that here is no difference in cost to consumers as a result of its pharmacy benefit program. But local pharmacists we interviewed tell us that is not true, and they say in some cases consumers would save money by buying their medication without insurance.

In Baton Rouge, a bill in the Louisiana State Senate would allow pharmacists to begin telling patients if their medication would be cheaper to buy without insurance. That bill, filed by Lake Charles Sen. Ronnie Johns, has stalled. 

Sources tell FOX 8 that Johns has received pressure from the insurance industry to pull the bill. Sources say Johns used to be a pharmacist, but is now an insurance agent.