Trending News Today: Pharmacists Concerned PBMs Pocketing Prescription Drug Savings

With the rise in copays and high-deductible insurance plans becoming more common, it may be cheaper for consumers to pay with cash, especially for generic drugs, instead of using their copays. Kaiser Health News reported that cash prices began to drop below copays a decade ago after stores started selling dozens of $4 dollar drugs. The added costs can run as high as $30 or more per prescription. Pharmacists said the money is mostly being pocketed by large pharmacy benefit management (PBM) firms responsible for handling claims for millions of Americans and pocketing the difference. Although there are certain situations where it would cost less to pay cash, experts warn that cash payments do not always count toward annual drug deductibles, so consumers with high drug costs might want to consider paying cash.

Despite the recommendation for individuals to start getting colon cancer screenings once they hit 50-years-old, there are still millions of Americans who haven’t been tested, reported Kaiser Health News. In order to get more Americans to go for screenings, a panel of experts on the US Preventive Services Task Force has updated and added new choices to its colorectal cancer screening guidelines. The new guidelines now include 2 additional ways to screen for the disease, including virtual colonoscopies called computed tomography (CT) colonography. The second screening option is a $650 home test called Cologuard, which checks stool for elevated levels of altered DNA that may indicate cancer. Although Medicare already covers Cologuard, there are still numerous private insurers that do not. It’s estimated that about 1 in 4 of people with private insurance who are in the targeted age range currently have coverage. Some consumers may have a copayment, even though preventive screenings are covered without deductibles or copayments.

California’s insurance commissioner has urged national antitrust regulators to block the merger of Aetna Inc and Humana Inc, reported The New York Times. The proposed merger is a $34 billion deal. According to California Insurance Commissioner David Jones, whose state Department of Insurance does not have the authority to block the deal, the acquisition would be anti-competitive in California and nationwide, contributing to higher prices for insurance.