Is Your Health Insurance Provider Overcharging for Prescription Drugs?

A recent medical waste investigation conducted by Fox8 News New Orleans revealed the nation’s largest insurance carrier, United HealthCare may be overcharging for prescription drugs – clawing back money from pharmacies and customers.

One of these consumers is Nicole S., a single mother of a seven-year-old boy.

Nicole’s son has a rare medical condition. “From the information from the ophthalmologist, it’s an allergic conjunctivitis that’s more rare, and found mostly in African-American males, young African-American males,” she explains.

Nicole took her son to the doctor, who prescribed an eye drop – a medication that cost $473.

She says just cannot afford a $473 medication. “And as a single parent I felt that I was failing,” she says, “not being able to provide the healthcare that he deserves.”

However, after watching Fox8’s medical waste investigation, the single mom started researching why the eye medication costs so much. Nicole discovered the problem may actually be her own insurance company overcharging for prescription drugs.

“I feel like I have options now,” Nicole told Fox8 “as a consumer but more than anything as a parent. “

In fact, she was able to find her son’s eye medication at a much cheaper cost without using her insurance. “I have found it actually at half-off,” she states.

Millions of insured individuals in the United States are under the impression that their insurance company is upfront and honest about the true cost of prescriptions and copays.

“You’re naturally assuming that your insurance is paying for part of the cost of the medication,” says Doug Hoey, CEO of the National Community Pharmacists Association, a trade group that represents independent pharmacies,

But according to the investigation, its pharmacy benefits management firms (PBMs) that actually control clawbacks.  The investigation points to documents from multiple pharmacists that show the PBM for United HealthCare, OptumRx, are frequently overcharging for prescription drugs.

Many of these pharmacists note that this practice is common with generic medications and insurance plans with high deductibles.

“Most consumers don’t know that you’ve got these middlemen called PBM’s, like Optum or Catamaran, in the middle of the transaction,” Hoey says. “And they manage hundreds of billions of dollars.”

United HealthCare actually owns one of the largest PBMs – OptumRx, one of the largest PBMs.

“The biggest PBM is bigger than Walt Disney, McDonalds and Ely Lilly combined,” Hoey tells us. “Those three iconic companies together are not as big as the biggest PBM, Express Scripts – yet most consumers have no idea what Express Scripts is.”

UnitedHealth Overcharging for Prescription Drugs

Fox8’s investigation isn’t the only one calling out UnitedHealth for overcharging for prescription drugs.  In October, three UnitedHealth customers filed a lawsuit against the largest health insurer in the country in Minnesota federal court.

According to the plaintiffs, the company is secretly overcharging for prescription drugs, stating co-payments for drugs were more expensive than the actual cost of the drugs and that UnitedHealth pocketed the difference.

The lawsuit uses the contraceptive Sprintec as an example, for which one member allegedly paid $50, while UnitedHealth only paid the pharmacy $11.65 — keeping the extra $38.85. While this was billed as a “co-payment,” the transaction is actually a “hidden additional premium,” the lawsuit claims.

Are You Being Overcharged for Your Prescription Drugs?

UnitedHealth isn’t the only healthcare insurance provider that may be overcharging for prescription drugs. Other health insurance companies under the same scrutiny are:

• Cigna
• Humana Inc.
• Aetna
• Kaiser

If you believe your health insurance company is overcharging for prescription drugs, you should contact a consumer fraud attorney for a free and confidential consultation about your potential legal claims.