Zurik: Consumer finds cheaper drugs without using Medicare - FOX 8 WVUE New Orleans News, Weather, Sports, Social

Zurik: Consumer finds cheaper drugs without using Medicare

NEW ORLEANS (WVUE) -

"I was like, this is crazy," Rick tells us in a Skype interview. "Definitely getting ripped off; we’re getting robbed."

Rick is a resident of New Jersey, and he found our Medical Waste stories online. He sent us an email with the subject, "United overcharging for drugs."

"Of course it angers me," He tells us. "It’s like, why are the drug companies robbing us? They’re robbing all the consumers…  Some days I don't even feel like getting out of bed."

Rick is on Medicare, pays $40 a month to take part in AARP's program - a program run by United Healthcare.

"I don't understand how it works," he says. "I asked the pharmacy; they can't tell either. It makes no sense. You figure [if] you’re using United Healthcare, OptumRx, you’re saving money. But you’re really not. This is where they fool you, by selling you these plans.

Rick sent us receipts from last Wednesday. He went to the pharmacy to buy prescription eye drops.  Through his United insurance, the pharmacist tried to charge him $52. He decided to pay without insurance. It cost him a lot less - $12 less.

"I figured it out, with all my prescription drugs, it’s cheaper not to use Medicare," Rick tells us.

Rick's not alone.  Our Medical Waste investigation showed how United Healthcare and its pharmacy benefit manager, OptumRx, overcharge some customers for prescription drugs. 

"This is a form of fraud," says Tulane law professor Joel Friedman. "You are expecting, as they have represented it, that you’re going to get a price that’s less, than the actual price, the retail price of the prescription drug. That’s why people buy insurance, because group buying power."

A pharmacist from the East Coast sent us new documents, showing recent examples.  A United customer battling insomnia was forced to pay $3.78 for his medication; United and Optum clawed back $14.89 from that copay, essentially overcharging the customer.

"Why else are you buying insurance?" Friedman wonders. "What's the point of insurance? 

Presumably most consumers purchase insurance to pay lower drug and other health costs. But instead, we've shown example after example of United Healthcare, charging customers more than the cost of the drug and clawing back the extra money from the pharmacy and customer.

Another example from that east coast pharmacist: a customer fighting depression. United overcharged this person $12. 

"The purchaser of the prescription is in some cases paying more through the insurance company’s arrangement than if they had no insurance," Friedman says. "That's criminal fraud.  That’s stealing… Because they are taking your property in a way that is improper, based on the representations they've made."

Friedman thinks La. Attorney General Jeff Landry needs to investigate and look out for policyholders in this state. Landry's office wouldn't confirm or deny if they've launched an investigation.

Congressman Buddy Carter, a Republican from Georgia, is the only pharmacist on Capitol Hill. He owned three independent pharmacies; now his wife's in control of those.  

And he says they are seeing clawbacks of customers at their own pharmacies.

"No question about it," Carter tells us.  "We see clawbacks every day."

Carter says federal laws will be introduced to stop the clawbacks. "We are filing legislation that would not only make it against the law for insurance companies to use these clawback mechanisms, but also… even to go as far as to prohibit insurance from owning their own pharmacies and forcing their patients to go to a certain pharmacy," he says.

What Carter's trying to prevent is a situation like this: United, forcing its customers to fill prescriptions through its subsidiary, Optum, which operates a mail order pharmacy.  So the insurance company sells the insurance, and then forces the customer to use a pharmacy also owned by the insurance company, eliminating choice for the customer.

"Now people are being told where they have to buy their medication from," Carter says.  "And they’re having to buy their medication from the same company that owns their insurance.  These companies are double-dipping, sometimes triple-dipping. And the profit is enormous."

Last week United reported second-quarter earnings jumped 11 percent to beat investor expectations.

Back in New Jersey, Rick is left to struggle with his med costs and wonder, "What am I paying for? What am I paying for?  Why am I paying $40 for it?  I’m not using it anymore."

Rick says he's canceling his United insurance. He believes he can save more than $300 a year, buying his prescriptions without it.

"It’s extra food on the table," he says.  "The money’s tight now - I used to make $80,000 a year, I’m making half, less than half of that now. You know, it’s more gas in the car and stuff like that… basic needs that you need around the house."

Rick thought pharmacy benefits card would help reduce his healthcare costs.  Now he and many other people are learning the company providing their insurance sometimes charges a premium for their prescription medication.

"It’s just crazy," Rick says. "How does the government allow something like this? You know, I’ll say this: I’m just a single consumer here and I notice it. How come nobody else is noticing it?"

Just so we're clear, we don't have any documentation that suggests United is clawing back money in the Medicare Part D program. The only documentation we received from Rick in New Jersey shows he was able to get it cheaper without insurance. In this case, he tells us he used a GoodRx app on his phone.

United told us by email, "Our goal is to help our members get the lowest available price for their prescriptions. Often the lowest price is their plan copay, other times it’s our contracted rate with the pharmacy, and sometimes it’s the pharmacy’s own retail or discount price. Our plans offer members security and peace of mind, and we encourage people to ask questions of their pharmacists to ensure they are getting the lowest available price for their prescriptions."

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