So here is a practice that I was unaware of: when the total cost of a prescription drug to an insurer or a pharmacy benefits manager is less than a patient/insured’s co-pay, the insurer or pharmacy benefits manager keeps the difference in a practice that is known as a “clawback.” Representative Andria Bennett has a new bill, HB24, that would end that practice.
According to a March 2018 report issued by the University of Southern California’s Schaeffer Center for Health Policy & Economics, almost 25% of filled pharmacy prescriptions involved a patient co-payment that exceeded the average reimbursement paid by the insurer by more than $2.00. The report further noted that overpayments were more likely to occur on claims for generic drugs than brand drugs and that the total overpayments in the Center’s sample amounted to $135 million.
My question is what happens to the clawbacked money? It’s obviously not given to the consumer, since a co-pay is a co-pay. The money goes to the insurance company, which I suppose the hope is would lead to lower co-pays. But the General Assembly might want to pass legislation to that affect. If I am understanding this correctly…
What is the bill? Out of Committee 1/23/19
Democratic Sponsors: Bennett, Sokola, Bentz, Dorsey Walker, Heffernan, Jaques, Kowalko, Seigfried, K.Williams
Republican Sponsors: Delcollo, Pettyjohn, Wilson
Yes Votes: Democrat, Republican
No Votes: Democrat, Republican