He couldn't afford his inhaler when the price soared without warning — and died days later

Often no one, from the patients to the drug companies to the insurers, is aware of the details of the decisions the PBMs are making. The “rebate” is the difference between the list price for a drug and what the PBM can buy it for, which can be “a very much lower number than the list price,” Anderson said. In January, CVS Health said in a statement that it “is inappropriate and misleading to draw broad conclusions from cherry-picked ‘specialty generic’ outliers” and that the company’s “top priority is to make health care more affordable.” OptumRx said that it helped eligible patients save $1.3 billion last year and estimated that the median out-of-pocket payment for these patients was $5.

Author: Jason Kane, Anne Thompson, Linda Carroll

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