Welcome to the Frontier Psychiatrists, a newsletter about health. Also, I have a full-length album released today. It’s called Perfect is the Enemy of the Good. It’s available on Spotify! Follow it, and I won’t be upset if you “listen to it” on repeat when you leave the house for the weekend. This is a joke.
Today’s Health News? I went to fill a prescription at Duane Reade, owned by Walgreens. I have insurance through an employer plan. To pick up my medicine using my insurance would have cost $54.11 as a copay, and I was informed the plan had saved me $761.88. This is an example of the Pharmacy Benefit Manager (PBM) racket, as I have documented at length in this article.
This seemed fishy. So I asked how much it would cost using CapitalRx built cost-plus PBM:
Anyone can use that card, by the way. Screenshot it. Free to use.
Here is what I paid in full: $24.32. So my Insurance didn't save me $761.88! It cost me 29 bucks, plus minus, and my plan had to pay again for the drug after the co-pay.
Who are the counterparties on the contract for that contracted rate?
A “no gag clause” law needs to be signed by everybody using health insurance to meet their fiduciary duty under ERISA. It will be hard to explain why making me pay 29 extra dollars to your Pharmacy benefit manager and then paying extra for the drug all over again is in my interest as a plan member. Times…most of America. That law goes into effect for every CEO and every CFO of every company covered by ERISA on December 31, 2023. Buckle up.
In the meantime, you could use a cost-plus PBM, like CapitalRX, just by using that card above. You could also use the Mark Cuban cost plus pharmacy and its associated pharmacy benefit manager. There are lots of things you can do. But your company? What it is probably doing right now is a breach of fiduciary duty. And it's costing you money.
You don't have to put up with it. Today, I didn't put up with it. I paid for my drug, I paid less, and I used the above card at the Pharmacy counter.
I do the same :) I’m actually in the middle of writing a guide to purchasing fertility meds inspired by the same freaking problem.
Thank you for enlightening me!