Quote:Actually you're wrong about pricing. It's against the law for any health care entity, pharmacy included, to price their drugs or services differently because of the insurance status of the customer. They can contract with insurance for lower reimbursement, but they cannot have a different list price, it has to be the same all the time. What's different is the amount of the contractual discounts from that price, those vary payer to payer and even contract to contract from the same payer.

 

Additionally, drug costs are reimbursed by insurance companies based on the Average Wholesale Price document produced by CMS each quarter. Most contracts are set in stone at the AWP so you don't negotiate them, you just get paid what the document says plus a small percentage. If the pharmacy is giving you a number it's the out of pocket expense which varies, not the shelf or list price because that really doesn't.

No offense, but how is the bolded part above not just a matter of semantics. If the actual price is different, what does a bogus 'list price' matter? If anything it seems to support the idea of price distortion Samjag was talking about. 

 

Any source for the second part in bold? It was my understanding that AWP did not apply to volume discounts, rebates etc, and that it was nowhere near as universal as you seem to state.

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