A consumer needs a prescription filled and goes to their local pharmacy. The pharmacist asks for your prescription benefits card, does some paperwork, gives you a generic drug and charges you according to your plan’s standard deductible, say $15.

That may seem like a typical experience, but what this consumer may not have known is that the generic drug could have been purchased for less than $5. In fact, there are many cases where generic drug prices are lower than plan deductibles. The practice is called clawbacks, and it’s just one of several ways that some pharmacy benefits managers (PBMs) are increasing drug costs and lining their pockets.

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