Good article from the Wall Street Journal blog here about generics, however in the example quoted below, the patient’s benefit payment of 146.53 just doesn’t come close to taking advantage of a cash prescription of the same drug for $10.00 for a 90 supply at Wal-Mart or Target. In this case with this particular drug, the cash paying patient will win if choosing this option as more than likely there’s at least a $10 or more co-pay. There are links on the site to PDFs that reference both the $4.00 and $10.00 prescription drugs available.
One note though, when a patient opts to pay cash and there are a number of patients in the practice that choose to do this, P4P (pay for performance) can reflect a potential negative hash mark on the participating physician as some programs when evaluating a physician for bonus money take in to effect how many generics are prescribed and the cash records for scripts purchased at a discount may not be available, thus the physician stands a chance of getting dinged if they are outside the guidance levels of prescribing their recommended percentage of generics as they are not tracked through the insurance company. BD
The differences between what the PBMs pay pharmacies and what they charge the plans can range from a few dollars to well over $100. In one case, a Medicare patient filled a prescription for a 90-day supply, or 270 pills, of the generic antinausea medication prochlorperazine. The difference between what the PBM, Express Scripts, paid the pharmacy and the price that showed up on the patient’s explanation of benefits was $146.53.