Prescription overpayments, often referred to as clawbacks, happen when patients pay more in copayments for a drug than it cost their insurer or pharmacy benefit manager. For the study, researchers examined CMS reimbursement data from a large commercial insurer for the six months beginning in January 2013. The authors combined the data with information on national average drug reimbursements to see which claims were likely overpaid.
Here are four findings from the study.
1. The 23 percent of claims that were possibly overpaid surpassed average reimbursement rates by more than $2, with an average overpayment of $7.69.
2. Claims for generic drugs were more likely to see clawbacks than brand drugs: 28 percent versus 6 percent, respectively. However, the average overpayment was smaller for generic drugs than brand drugs: $7.32 versus $13.46.
3. Potential overpayments in the study period totaled $135 million within the authors’ sample. This equated to roughly $10.51 per covered life.
4. “With over 200 million Americans commercially insured in 2013, these findings suggest the practice of overpayments may account for a nonnegligible share of overall drug spending and patient out-of-pocket costs,” the authors concluded.
For the full study, click here.
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