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The Curious Incident of the $44,000 Prescription

Dr. Jeff Blumberg

“For $44,000 a month for a nutritional supplement — I don’t see what that could be other than a scam,” said Dr. Jeff Blumberg, the director of the Antioxidants Research Laboratory at Tufts University and a leading expert on nutritional supplements.

“It’s not the cost of the ingredients, it’s not the cost of formulating them, it’s not the cost of shipping them,” he added. “This is thousands of times more expensive than what you can buy it for anywhere else.”

In fact, you can buy it for thousands less at Warner West, the very same pharmacy that filled the $44,000 prescription.

Wearing hidden cameras, we asked their pharmacist about buying Resveratrol without insurance and were quoted a very different price.

“One capsule, twice daily, that one you’re looking at almost $200,” said the pharmacist. “If your doctor wants to send it over, then we can run it through your insurance, and see if it’s covered and let you know what they’ll pay for.”

At that price the CBS News employee’s prescription would have cost about $600 out of pocket — more than 70 times less than the $44,000 claim approved by CVS/caremark, the prescription benefits manager for CBS News.

We wanted to ask CVS/caremark why they would ever pay that much for a non-FDA approved nutritional supplement, but they refused to discuss it on camera.

As for whether this is legal, there is no indication any law has been broken in this case. A lawyer for Warner West pharmacy told us Warner West submitted a government billing code. He said the insurance company arrived at $44,000 based on the manufacturer’s recommended price associated with that billing code.

Source:  CBS NEWS

Tyrone Squires, MBA, CPBS

I am the proud founder and managing director of TransparentRx, a fiduciary-model PBM based in Las Vegas, Nevada. We help health plan sponsors reduce pharmacy spend, by as much as 50%, without cutting benefits or shifting costs to employees.

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