Take the Generic Drug, Patients Are Told — Unless Insurers Say No
In recent months, some insurers and benefit managers have insisted that patients forgo generics and buy brand-name drugs. “It’s Alice-in-Wonderland time in the drug world,” says one physician.
This article first appeared August 06, 2017 on ProPublica.
by Charles Ornstein, ProPublica, and Katie Thomas, The New York Times
It's standard advice for consumers: If you are prescribed a medicine, always ask if there is a cheaper generic.
Nathan Taylor, a 3-D animator who lives outside Houston, has tried to do that with all his medications. But when he fills his monthly prescription for Adderall XR to treat his attention-deficit disorder, his insurance company refuses to cover the generic. Instead, he must make a co-payment of $90 a month for the brand-name version. By comparison, he pays $10 or less each month for the five generic medications he also takes.
"It just befuddles me that they would do that," said Taylor, 41.
A spokesman for his insurer, Humana, did not respond to multiple emails and phone calls requesting comment.
With each visit to the pharmacy, Taylor enters the upside-down world of prescription drugs, where conventional wisdom about how to lower drug costs is often wrong.
Consumers have grown accustomed to being told by insurers - and middlemen known as pharmacy benefit managers - that they must give up their brand-name drugs in favor of cheaper generics. But some are finding the opposite is true, as pharmaceutical companies squeeze the last profits from products that are facing cheaper generic competition.
Out of public view, corporations are cutting deals that give consumers little choice but to buy brand-name drugs - and sometimes pay more at the pharmacy counter than they would for generics.