Copayment costs out of control? - SpecialtyRx
March 19, 2018
Copayment costs out of control?

New research suggests copays are exceeding drug costs

Who’s to blame: pharmacies or insurance companies?

From Medicare and Medicaid to long-term care insurance and out-of-pocket payment, residents navigate a complex maze when it comes to securing their nursing home, subacute care and similar coverage. But beyond our patients’ distinct challenges, the question of copayment remains an ever-present problem across the United States, especially with regards to prescription drugs.

A recent study from the Journal of the American Medical Association says an astounding 23% of all prescriptions are affected by overpayment. In other words, patient contributions—even when seemingly insignificant—are exceeding the price of the drugs themselves. Here’s a look at some of the statistics published in March of 2018.


Copayment-costs image

Who’s culpable for these claims?

How ‘overpayment’ happens is a tricky subject. Are pharmacies being complacent about excess reimbursements? Or are inflated insurance copays ultimately to blame?

The fact is our systems are so intricately intertwined that it’s tough to say. Many industry experts suggest pharmacists might be more transparent about what’s available to patients. Regulation dictates what information technicians can voluntarily ‘offer,’ versus what pointed questions they may answer (considering ‘gag’ clauses).

“To avoid overpayments, patients should always ask the pharmacist if their costs would be lower if they paid cash instead of using their insurance,” says Stacie B. Dusetzina, Ph.D., of Vanderbilt University Medical Center. “If patients ask, pharmacists can tell them.”

Cash dynamics are always slightly different when medication dispensing is handled in hospitals, nursing homes and other professional facilities. Still, it’s important that administrators stay informed about big trends happening in the world of Rx.

At SpecialtyRx we work closely with LTC facilities to ensure patients always receive the fairest, most economical prices for their prescription drug needs. Trust our staff to stay abreast of the current overpayment crisis.