We are overpaying for prescription migraine medication...and we may not even know it. A recent study released by the Henry J Kaiser Family Foundation revealed that 77% of Americans believe that the costs of medical prescriptions are unreasonably high and an additional 26% struggle to pay for their prescribed medications. Last year, drug costs rose at an astonishing 10% over the course of a 12 month period. But it is one hidden policy between insurance companies and many pharmacies—known as clawbacks—which may not only be raising your medication prices, but is also raising debates about health-related pricing transparency. In this post, we analyze the issue and give you practical tips for the cost-effective treatment of migraine.
The frustrating truth about your insurance copay and "clawbacks"
Insurance copays seem like a great deal. You pay an agreed upon amount—something that seems very reasonable and affordable—as part of a health insurance plan for prescribed medication to treat an illness or condition. This medication, which may be significantly more expensive out of pocket, is covered by insurance and does not break the bank. But ‘clawbacks’ may mean that your copay for that medication is actually more expensive than the cost of not using your insurance, especially if it is a generic drug. And the worst part is pharmacists oftentimes cannot even tell you that you are paying more.
How do clawbacks work?
In effect, drug benefit managers negotiate with pharmacies for prescription co-pays—often at a premium compared to the cost of the drug—and they then divide the gains from the transaction, with most of the proceeds going to the benefit manager. These price hikes can be as little as $2 or as high as $30 per prescription. Many pharmacists argue that their business would be dramatically impacted without insurance reimbursement networks, thus furthering the use of these policies. And contracts often prohibit pharmacists from volunteering this information to customers, according to a recent Bloomberg report.
Other ways clawbacks can impact patients with migraine
Migraine sufferers are among those hit hard by prescription price hikes. Triptans, which can be highly effective in reducing the severity and length of headaches, already come with a hefty price tag. It has also been suggested that many with migraine hoard their prescriptions or wait until an attack becomes severe in an effort to conserve them. These combined effects may be why patients do not take triptans for an attack over 40% of the time when they could otherwise be helpful, at least according to one study. This can result in heightened pain during attacks, the need for greater doses of medication to treat them, or even emergency room care for migraine, as well other consequences. Artificial price increases to migraine medication through policies like clawbacks only serve to make these issues worse.
How you can avoid the effects of clawbacks
If you or a loved one are among the millions of Americans who are affected by migraine, there are ways to effectively reduce the burdens felt by patients and their families from clawbacks and other pharmaceutical policies.
Research prices of generic and brand name drugs
The first thing to do is compare costs of generic drugs and brand name drugs, both with and without insurance. Find out if there are generic forms of effective medications available that may reduce prescription costs. It may also be beneficial to look into prescription assistance programs, Medicaid, or free or sliding scale clinics in your area.
Preventative and alternative treatments
Identify alternative forms of treatment and prevention beyond medication. For example, specially tinted glasses can help to ward off migraine attacks aggravated by light. Important tip: When purchasing these or any other alternatives, be sure to check into the return policy and also find out if your insurance will cover all or part of the cost.
Advocate for pricing transparency
Become an informed and vocal advocate for pricing transparency in health care. Educate yourself on legislation and public policy and contact local, state and federal representatives to let them know that you support transparency in health care.