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After a transient ischemic attack while traveling, Gretchen Liu was prescribed telmisartan by her doctor.  She filled the prescription directly through her Pharmacy Benefit Manager Express Scripts’s mail-order service.  The copay for the 90-day supply of the generic drug was $285.

A month later, she needed to stock up on the medication for another extended trip, but, because 90 days hadn’t passed, she wasn’t eligible to get the prescription through her prescription benefits.  So she went to Costco and paid cash out of pocket.  The grand total was about $40.

““I was very shocked.  I had no idea if I asked to pay cash, they’d give me a different price,” her husband said according to PBS News Hour where the story was first reported.

Worse still, the PBM can actually take some of the additional money that was charged to the customer back from the pharmacy in a controversial practice known as a “clawback”.  To many, it feels like double-dipping into the consumer’s pockets; once for the premium to maintain the coverage and then again for the overcharged amount versus someone who had no coverage at all.

All of this just reinforces the old adage “caveat emptor” (buyer beware).  And it’s a reminder to consumers to not just check the cash price, but also check prescription drug discount programs like GoodRx and Blink Health who may offer dramatically lower prices than simply paying cash at the register of your local pharmacy.