{"id":2639456,"date":"2026-08-03T03:21:02","date_gmt":"2026-08-03T07:21:02","guid":{"rendered":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/utm_sourcerssutm_mediumrssutm_campaignhow-obamacare-pushes-big-pharma-to-overcharge-you-for-prescriptions\/"},"modified":"2026-08-03T03:31:43","modified_gmt":"2026-08-03T07:31:43","slug":"utm_sourcerssutm_mediumrssutm_campaignhow-obamacare-pushes-big-pharma-to-overcharge-you-for-prescriptions","status":"publish","type":"post","link":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/utm_sourcerssutm_mediumrssutm_campaignhow-obamacare-pushes-big-pharma-to-overcharge-you-for-prescriptions\/","title":{"rendered":"How Obamacare Pushes Big Pharma To Overcharge You"},"content":{"rendered":"<aside class=\"mashsb-container mashsb-main mashsb-stretched\"><div class=\"mashsb-box\"><div class=\"mashsb-count mash-medium\" style=\"&quot;\"><div class=\"counts mashsbcount\">16<\/div><span class=\"mashsb-sharetext\">SHARES<\/span><\/div><div class=\"mashsb-buttons\"><a class=\"mashicon-facebook mash-medium mash-nomargin mashsb-noshadow\" href=\"https:\/\/www.facebook.com\/sharer.php?u=https%3A%2F%2Fwww.conservativenewsdaily.net%2Fbreaking-news%2Futm_sourcerssutm_mediumrssutm_campaignhow-obamacare-pushes-big-pharma-to-overcharge-you-for-prescriptions%2F\" target=\"_top\" rel=\"nofollow\"><span class=\"icon\"><\/span><span class=\"text\">Facebook<\/span><\/a><a class=\"mashicon-twitter mash-medium mash-nomargin mashsb-noshadow\" href=\"https:\/\/twitter.com\/intent\/tweet?text=&amp;url=https:\/\/www.conservativenewsdaily.net\/breaking-news\/?p=2639456&amp;via=ConservNewsDly\" target=\"_top\" rel=\"nofollow\"><span class=\"icon\"><\/span><span class=\"text\">Twitter<\/span><\/a><a class=\"mashicon-subscribe mash-medium mash-nomargin mashsb-noshadow\" href=\"#\" target=\"_top\" rel=\"nofollow\"><span class=\"icon\"><\/span><span class=\"text\">Subscribe<\/span><\/a><div class=\"onoffswitch2 mash-medium mashsb-noshadow\" style=\"display:none\"><\/div><\/div>\n            <\/div>\n                <div style=\"clear:both\"><\/div><\/aside>\n            <!-- Share buttons by mashshare.net - Version: 4.0.47--><p>The article recounts a personal experience highlighting the complexities and frustrations of the healthcare and pharmacy benefit systems, specifically with CVS Health&#8217;s <a href=\"https:\/\/www.conservativenewsdaily.net\/breaking-news\/there-are-always-going-to-be-ways-activists-reportedly-plan-to-defy-pro-life-laws-if-roe-is-overturned\/\" title=\"\u2018There Are Always Going To Be Ways...: Activists Reportedly Plan To Defy Pro-Life Laws If Roe Is Overturned\">mail-order pharmacy<\/a>. Over nearly a year, the author struggled to get clear answers about why their prescription was being provided in smaller quantities then prescribed, only discovering that coverage restrictions labeled the medication as a non-maintenance drug. Attempts to navigate the appeals process were hindered by vague notices and insufficient information, pointing to deliberate obfuscation by the <a href=\"https:\/\/www.conservativenewsdaily.net\/breaking-news\/bipartisan-legislation-to-mandate-healthcare-cost-transparency-passes-house-committee\/\" title=\"Bipartisan bill for ... cost transparency clears House committee.\">pharmacy benefits manager<\/a> (PBM) and associated third-party vendors.Frustrated with the opaque and bureaucratic process, the author opted to pay cash at a local pharmacy, frequently enough getting the medication at a <a href=\"https:\/\/www.conservativenewsdaily.net\/breaking-news\/u-s-consumer-watchdog-plans-to-regulate-buy-now-pay-later-companies\/\" title=\"U.S. consumer watchdog plans to regulate \u2018buy-now, pay-later... companies\">significantly lower cost<\/a> than through insurance. they emphasize that large corporations profit by complicating the prescription process and overcharging consumers, advocating for patients to explore all options-including paying cash-to save money and time. The story underscores systemic issues in the healthcare system, such as profit-driven practices by PBMs and the need for greater transparency.  <\/p>\n<p class=\"readmore\">\n    <button onclick=\"showReadMore()\" id=\"readmorebtn\">Read more&#8230;<\/button>\n<\/p>\n<hr id=\"line\">\n<span id=\"more\"><\/p>\n<div>\n<p>As if our health care \u201csystem\u201d wasn\u2019t already complicated enough, here\u2019s example No. 9,572.<\/p>\n<p>I spent the better part of <em>one year<\/em> trying to ask a prescription drug provider one simple question about my prescription. Even as someone who works in health policy and with advocates on my behalf, I kept getting the run-around.<\/p>\n<p>Unfortunately, as I found out firsthand, big conglomerates \u2014 in this case, CVS Health \u2014 make profits by keeping the system complicated, bureaucratic, and opaque. But (eventually) I found out there\u2019s a simple solution: returning to good, old-fashioned cash transactions.<\/p>\n<h2><strong>Mail Order Madness<\/strong><\/h2>\n<p>The saga started last summer, when my physician prescribed a maintenance medication to prevent a recurrence of <a href=\"https:\/\/thefederalist.com\/2024\/05\/15\/when-woke-medicine-becomes-dangerous-to-your-health\/\" target=\"_blank\" rel=\"noreferrer noopener\">kidney stones<\/a>. My doctor sent a prescription to CVS Caremark, requesting a 90-day mail-order supply of the drug. CVS is the pharmaceutical benefits manager (PBM) that administers my prescription.<\/p>\n<p>When it arrived, I received the following note:<\/p>\n<blockquote>\n<p><strong>We filled your prescription with a smaller quantity than what your doctor prescribed.<\/strong> Your prescription plan has limits on the amount of your medication it will cover. We filled your prescription according to these limits. [Emphasis original.]\n<\/blockquote>\n<p>For the better part of 12 months, I communicated with CVS staff, trying to figure out the reasons for this decision. I also asked a representative from the District of Columbia\u2019s Office of Health Care Ombudsman to investigate on my behalf. Every time my physician prescribed a 90-day supply of this medication, CVS Caremark sent me a 30-day supply of the drug, along with the same note described above.<\/p>\n<p>A few weeks ago, I finally spoke with a CVS representative who could tell me the reason. While my prescription plan covered the drug, it did <em>not<\/em> cover it as a maintenance medication. This explained why CVS Caremark kept lowering the medicine supplied from 90- to 30-day supplies.<\/p>\n<p>The representative informed me I could use an exceptions process, through which my physician could send a form to CareFirst (my insurer) providing clinical justification to use the drug for maintenance purposes. If approved by CareFirst, then CVS Caremark would honor the 90-day prescription, and provide me with a three-month supply of the drug going forward.<\/p>\n<p>This annoyed me, because I had mentioned the exceptions process (which I know about from working in health policy) while speaking to CVS personnel last summer. That individual never provided me the information I had asked for, which could have saved me months of hassle.<\/p>\n<p>I contacted CVS\u2019 corporate office to ask two simple questions: why did the notices I received refer to \u201cyour prescription plan\u201d \u2014 a wording that seems deliberately vague as to whether my insurer (CareFirst) or the PBM (CVS Caremark) made the coverage decision; and why didn\u2019t those notices also include specific, written instructions on how request an appeal or exception for longer-term coverage of the drug?<\/p>\n<p>CVS\u2019s communications team sent back this response:<\/p>\n<blockquote>\n<p>CareFirst is the plan sponsor, and CVS Caremark helps support the administration of the plan\u2019s pharmacy benefit.\u00a0This CareFirst plan relies on an expert third-party vendor, Medispan, to determine which medications are considered maintenance drugs versus acute.\u00a0Because Medispan lists potassium citrate as a non-maintenance drug, it is subject to the CareFirst plan\u2019s non-maintenance day supply limit of 30 pills.\u00a0Members have access to an exceptions process, which is administered directly by CareFirst.<\/p>\n<\/blockquote>\n<p>This response didn\u2019t answer my questions about notice wordings. In fact, it suggests that a heretofore undisclosed third party (Medispan) made the decision that limited my prescription. Given CVS\u2019s non-answer, a cynic would suggest the obvious yet unstated reason the notice omitted information about filing an appeal or exceptions request: <em>If people knew about an exceptions process, they might use it<\/em>.<\/p>\n<h2><strong>Pay Cash Elsewhere<\/strong><\/h2>\n<p>Ultimately, I realized arguing with CVS Caremark over 90-day coverage of this drug wasted not just my time, but also my money. Talk of the <a href=\"https:\/\/trumprx.gov\/browse\" target=\"_blank\" rel=\"noreferrer noopener\">TrumpRx<\/a> platform prompted me to look into <a href=\"http:\/\/thefederalist.com\/2018\/09\/20\/senate-republicans-refuse-let-states-control-price-shopping-prescription-drugs\/\" target=\"_blank\" rel=\"noreferrer noopener\">discounted options<\/a> to obtain the drug without using my insurance. For instance, CVS Caremark charged me several times more ($45.81) than what Cost Plus Drugs (<a href=\"https:\/\/www.costplusdrugs.com\/medications\/potassium-citrate-er-15meq-1620mg-tablet-extended-release-urocit-k\/?quantity_units=60\" target=\"_blank\" rel=\"noreferrer noopener\">$10.93 plus shipping<\/a>) or Pharmacy Checker (<a href=\"https:\/\/www.pharmacychecker.com\/potassium+citrate\/15+meq\/#!\" target=\"_blank\" rel=\"noreferrer noopener\">as low as $17.27<\/a>) would charge me for the same prescription.<\/p>\n<p>By paying cash rather than using the CVS Caremark benefits available through my insurance policy, I ended up paying less for a 90-day supply of the prescription by using a discount code at a <a href=\"https:\/\/amzn.to\/3YuVZYV\" >local grocery store pharmacy<\/a> than CVS Caremark would have charged me for another 30-day prescription. Paying cash means that the cost of the prescription won\u2019t get applied to my annual insurance deductible, but as I\u2019m on a <a href=\"http:\/\/thefederalist.com\/2018\/08\/06\/short-term-plans-not-junk-insurance-obamacare\/\" target=\"_blank\" rel=\"noreferrer noopener\">junk Obamacare plan<\/a>, I won\u2019t meet that deductible anyway unless I have a major medical emergency.<\/p>\n<p>When asked about their high pricing, CVS\u2019 communications team claimed that \u201cthe same medication can have different member costs depending on the plan and pharmacy selected.\u201d But as <a href=\"https:\/\/thefederalist.com\/2023\/12\/01\/like-trump-elizabeth-warren-believes-obamacare-sucks\/\" target=\"_blank\" rel=\"noreferrer noopener\">this publication<\/a> and <a href=\"https:\/\/www.warren.senate.gov\/wp-content\/uploads\/media\/doc\/2023.11.21%20Letter%20to%20HHS%20OIG%20regarding%20MLR%20evasion.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">others<\/a> documented, <a href=\"https:\/\/www.conservativenewsdaily.net\/breaking-news\/medicare-pays-34000-more-than-we-do-for-this-7-cancer-drug-pharmacy-owner\/\" title=\"Medicare Pays 34,000% More Than We Do for This  Cancer ...: Pharmacy Owner\">health care conglomerates<\/a> like CVS often <a href=\"https:\/\/www.wsj.com\/health\/healthcare\/generic-drugs-should-be-cheap-but-insurers-are-charging-thousands-of-dollars-for-them-ef13d055?ns=prod\/accounts-wsj\" target=\"_blank\" rel=\"noreferrer noopener\">overcharge customers<\/a> for prescription drugs, to shift profits from their insurance business (where profits are capped by Obamacare\u2019s medical loss ratio) to their pharmacy business (where profits are not capped).<\/p>\n<p>This story illustrates how PBMs like CVS Caremark can profit by overcharging patients for drugs, and making the prescription drug system more complicated. Patients should look into <em>all<\/em> their options. Paying cash could end up saving you a bundle of money, not to mention time.<\/p>\n<hr>\n<div>\n<p>      Chris Jacobs is founder and CEO of Juniper Research Group and author of the book &#8220;<a href=\"https:\/\/www.amazon.com\/dp\/1645720020\">The Case Against Single Payer<\/a>.&#8221; He is on Twitter: <a href=\"http:\/\/twitter.com\/chrisjacobsHC\">@chrisjacobsHC<\/a>.<\/p>\n<\/div><\/div>\n<p><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Health system chaos: a year of prescription confusion<\/p>\n","protected":false},"author":521,"featured_media":2639457,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_mo_disable_npp":"","fifu_image_url":"https:\/\/thefederalist.com\/wp-content\/uploads\/2026\/07\/pexels-karola-g-4386225-scaled.jpg","fifu_image_alt":"","footnotes":""},"categories":[33651],"tags":[4606,12589,21542],"class_list":["post-2639456","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-the-western-journal","tag-healthcare","tag-obamacare","tag-pharmaceuticals"],"fifu_image_url":"https:\/\/thefederalist.com\/wp-content\/uploads\/2026\/07\/pexels-karola-g-4386225-scaled.jpg","_links":{"self":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts\/2639456","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/users\/521"}],"replies":[{"embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/comments?post=2639456"}],"version-history":[{"count":3,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts\/2639456\/revisions"}],"predecessor-version":[{"id":2639462,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts\/2639456\/revisions\/2639462"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/media\/2639457"}],"wp:attachment":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/media?parent=2639456"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/categories?post=2639456"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/tags?post=2639456"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}