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Are you paying too much for your prescription drugs? Contact attorney Gretchen Obrist to learn more about whether you have been subject to unlawful “clawbacks.” Call 800-776-6044 or email

Prescription Drugs Cost Too Much? What You Need to Know About Clawbacks

It may seem counter-intuitive, but sometimes paying the out-of-pocket cost for a prescription drug and bypassing your health insurance plan is the cheaper route. When insured customers are charged a higher copay for a drug than its actual cost, it is often the result of a “clawback.”  In these instances, using your insurance doesn’t save you money.

The University of Southern California Schaeffer Center for Health Policy & Economics studied this practice. The study analyzed prices that 1.6 million people paid for 9.5 million prescriptions in the first half of 2013. It found that overpayments totaled $135 million during that period. Researchers compared the copay to what a patient’s insurer paid for a drug and found that customers overpaid for their prescriptions 23 percent of the time, with an average overpayment of $7.69. The drug with the most frequent clawbacks was zolpidem tartrate—generic Ambien.

Here’s what you need to know about this controversial yet common practice:

  1. Pharmacy benefit managers (PBMs) and insurers pocket the difference between the copayment and full cost of the drug. For instance, if your copayment is $20 and the drug’s actual cost is $15, PBMs and insurers “claw back” the $5 difference for profit.
  2. Your pharmacist won’t tell you that paying cash would be cheaper because of “gag clauses” in pharmacy contracts. Several states including Connecticut, Arkansas, Louisiana, and Texas have passed laws aimed at eliminating clawbacks, gag clauses, or both, and Ohio recently implemented a rule prohibiting clawbacks and concealment of the practice. Critics are advocating for more transparency.
  3. These clawbacks are contributing to the high costs of prescription drugs. Keller Rohrback L.L.P. has filed and is litigating suits against OptumRx, CIGNA Corp. and UnitedHealth for their clawback schemes. Learn more about the cases here.

Please contact attorney Gretchen Obrist to learn more about whether you too have been subject to unlawful “clawbacks.” Call 800-776-6044 or email

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