SEATTLE--(BUSINESS WIRE)--Attorney Advertising. Patients who are paying a co-pay at the pharmacy may in fact be paying the entirety of the prescription cost plus an additional kickback to their Pharmacy Benefits Manager (PBM). Pharmacists refer to this practice as a “clawback” and you may have no idea that it’s happening to you.
PBMs act as a middle man between insurance companies and pharmacies. Pharmacists must submit claims to the PBM and then the PBM tells the pharmacy how much to charge each patient. The PBM can set the price well above what the drug actually costs.
For example, a document obtained by Fox 8 in New Orleans shows Valsartan HCTZ, a medication that treats high blood pressure, costs $14.43 but the PBM instructed the pharmacy to collect a $30 co-pay from the patient. The PBM paid nothing for the drug and then collected the additional $15.57 clawback from the pharmacy. This conduct is outrageous and unjustified.
Keller Rohrback L.L.P. is investigating the following PBMs for engaging in this practice:
- OptumRx, a subsidiary of United Health Group (Aetna Inc., CIGNA Corporation, Humana, OptumRx and Catamaran)
- Express Scripts
- Prime Therapeutics, a subsidiary of Blue Cross Blue Shield
- Navitus Health Solutions
If one of the companies listed above is your PBM and you suspect you are being overcharged at the pharmacy, please contact attorneys Derek Loeser, Erin Riley and David Ko. Call 800-776-6044 or email firstname.lastname@example.org.
Keller Rohrback L.L.P. has decades of experience helping consumers and insureds fight back against fraud and abuse. Keller Rohrback L.L.P. serves as lead and co-lead counsel in class action lawsuits throughout the country. With offices in New York, Seattle, Phoenix, Ronan, Oakland, and Santa Barbara, our Complex Litigation Group is proud to offer its expertise to clients nationwide. Our trial lawyers have obtained judgments and settlements on behalf of clients in excess of seven billion dollars.
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