When a CBS News employee was recently prescribed a nutritional supplement to boost his energy, he was astonished when he saw the claim the pharmacy submitted -- and his insurance approved -- for a one month supply: $44,707.
For the cost of a BMW convertible, he got 180 capsules of powdered resveratrol, an antioxidant found in red grapes, available at any local nutrition store.
In fact, two bottles of another brand of resveratrol contain roughly the same amount as the $44,000 prescription, which raises an even more puzzling question: Why does the over-the-counter resveratrol cost just $157.38?
We wanted to ask Warner West Pharmacy in Los Angeles -- the pharmacy that filled the prescription and submitted the claim -- why theirs cost so much more, but they declined our repeated requests for an interview...
"For $44,000 a month for a nutritional supplement -- I don't see what that could be other than a scam," said Dr. Jeff Blumberg, the director of the Antioxidants Research Laboratory at Tufts University and a leading expert on nutritional supplements.
"It's not the cost of the ingredients, it's not the cost of formulating them, it's not the cost of shipping them," he added. "This is thousands of times more expensive than what you can buy it for anywhere else."
In fact, you can buy it for thousands less at Warner West, the very same pharmacy that filled the $44,000 prescription.
Wearing hidden cameras, we asked their pharmacist about buying resveratrol without insurance and were quoted a very different price...
We wanted to ask CVS/caremark why they would ever pay that much for a non-FDA approved nutritional supplement, but they refused to discuss it on camera.
As for whether this is legal, there is no indication any law has been broken in this case. A lawyer for Warner West pharmacy told us Warner West submitted a government billing code. He said the insurance company arrived at $44,000 based on the manufacturer's recommended price associated with that billing code.
See: http://www.cbsnews.com/news/prescription-resveratrol-supplement-expensive-investigation/
Courtesy of: http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/52133?isalert=1&uun=g906366d4144R5793688u&xid=NL_breakingnews_2015-06-15
CVS Health Corp. deliberately overcharged some pharmacy customers for generic drugs by submitting claims to their insurance companies at inflated prices, according to a lawsuit filed Thursday in federal court in San Francisco.
ReplyDeleteThe suit says those inflated prices led to higher co-pays for customers that exceeded what they would have paid for the drugs if they had no insurance and participated in a CVS discount program.
"We've seen people who pay $20 for a 30-day supply as their copayments on a drug that was $11.99 for a 90-day supply had they been in the (discount program)," said Kristen Broz, an attorney with Hausfeld, the firm that filed the suit.
The lawsuit seeks class-action status, a court order prohibiting CVS from engaging in the behavior, and unspecified damages.
Broz estimated that hundreds of thousands of people may have been affected since 2008...
At issue in the lawsuit is CVS's "Health Savings Pass" program, which offers discounts to customers who do not have insurance or choose not to use insurance on hundreds of generic prescription drugs, including generic versions of the antibiotic Penicillin and the antidepressant Prozac, according to the suit.
Instead of presenting insurance companies with that discounted price, CVS reported the higher price that a normal retail customer not in the Health Savings Pass would pay, the lawsuit alleges.
Customers were then charged co-pays according to those higher prices.
"Not only was the HSP program a means by which CVS could maintain and increase its market share by fending off discounted prices from its competitors, but importantly, CVS also intended that the HSP program would serve as a mechanism to hide CVS's true usual and customary prices from third-party payors," the lawsuit says.
http://www.usnews.com/news/business/articles/2015/07/30/lawsuit-accuses-cvs-health-of-overcharging-for-generic-drugs