Specialty Pharmacy Scam - Same Drug Ranges from $37.41 to $2,172

Generic Specialty Pharmacy Scam. The generic version of the Multiple Sclerosis Drug Tecfidera is called Dimethyl Fumarate. This generic medication has been available since 2020.

Usually when a drug becomes generic its price goes WAY DOWN.

However, the Dimethyl Fumarate has a HUGE variability in cost depending on which pharmacy you use to fill it.

Grocery store pharmacies like HEB, Giant, Publix and Jewel-Osco sell Dimethyl Fumarate for $37 to $104 for a one month supply.

However, Costco, Walmart, Walgreens and CVS sell the exact same generic medication for $1,500 to $2,171.

That's 58 TIMES more expensive.

For employer-sponsored health insurance plans, that higher cost is being paid by the employer.

Solution: Exclude Dimethyl Fumarate from your PBM formulary, have plan members pay cash at the lower cost pharmacies and then reimburse them the cost.

You don't even need to use a Patient Assistance Program.

Sources:

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[unebonnevie]

Thank you for pointing out the greed at the stores that are actually wolves in sheep clothing, tricking people that they are actually saving money for their customers! This is a very shameful thing done by these BIG chains of stores!

[unebonnevie]

Perhaps Dr. Bricker is a few of the people that sow the seed of healthcare reform or revolt, for that matter, in this country. Appreciate your channel, Dr. Bricker!

[TakiffanyWilliams]

thanks for this informative video. I work PBM and I see this type of foolery everyday, and its sad.

[drshanep]

ALWAY check the cash price even if insurance.

[sue]

Thank you, Dr. Bricker! Unfortunately, I only have a Walmart near me!

[neilturnage]

Great video.

Why do you recommend that SF employers simply elect to remove Dimethyl Fumarate from formulary? Couldn't an employer just continue to cover the drug and communicate to employees to utilize GoodRx outside of insurance? What's the benefit of removing the drug from the formulary?

[utubesbydano]

I may be missing something. If both pricing examples (GoodRx) vs (Walmart, Costco, etc) are based off of, or similar to various PBM's contractual Specialty let's say a typical PBM's contractual pricing for Specialty is AWP - 20-25%. How do we end up with such a huge price disparity if we don't see similar PBM contractual pricing differences for Specialty? Hope this makes sense. Thanks!