The traditionally insured prescription world relies on something called the pharmacy benefit manager or PBM.

“A pharmacy benefit manager is the middleman between the insurance company and the pharmacy,” Antonio Ciaccia from the Ohio Pharmacists Association said.

According to Ciaccia, the three biggest middlemen in the business, Express Scripts, CVS Caremark and Optum Rx, represent more than 70 percent of the patients in the U.S. marketplace.

“They are able to use those patient lives to their advantage to negotiate better pricing on drugs or lower reimbursements to pharmacies because of the bodies they represent,” Ciaccia said.

But some pharmacy owners say not all patients are seeing that better pricing. They did not want to share their names because they say they signed contracts to work with the PBMs’ patients and those contracts have rules.

“Part of the provisions in those contracts…explicitly prohibit a pharmacist from saying anything that would be derogatory or negative against the PBM,” Ciaccia explains. That includes letting a customer know when he or she might be paying perhaps more than they should.

He calls money the PBM makes by overcharging the patient a ‘clawback.’

“This isn’t the rule of thumb, but we’re seeing it more and more where the patient is charged a higher co-pay than the cost of the drug would be without insurance,” he said.

Click here to read the entire story from WBNS-10TV.

To read a similar piece that aired earlier this week, please click here.