A woman insured by Anthem was paying $285 for a generic heart medication prescription. Recently, she was planning to go overseas for months and wanted to stock up on the medicine, but Anthem wouldn't give it to her because her previous prescription had not yet run out. So she went to Costco and bought the medicine. She was surprised that is cost only $40.
A spokesperson for the company that Anthem uses to manage its prescription drug program had no explanation for the price difference, other than the fact that Costo sometimes offers generic drugs for a lower price. No shit, sherlock. (In a June post, Cory gave the real reason: insurance companies have "successfully lobbied for gag rules that keep pharmacists" from being able to tell patients that it is often cheaper to buy medicines with cash.)
In the case of Express Scripts, the company manages pharmacy benefits for insurers and also provides a prescription mail-delivery service.
Express Scripts spokesperson Brian Henry confirmed to PBS NewsHour Weekend the $285 copay that Ma paid in 2016 for his wife's telmisartan was correct, but didn't provide an explanation as to why it was so much higher than the $40 Costco price. Henry said that big retailers like Costco sometimes offer deep discounts on drugs through low-cost generics programs.
USC's Geoffrey Joyce said it is possible that Costco negotiated a better deal on telmisartan from the drug's maker than Express Scripts did, and thus could sell it for cheaper. But, he said, the price difference, $285 versus $40, was too large for this to be the likely explanation.