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.

Question:  If there is such a large price difference among pharmacies, why don’t patients naturally fill their prescriptions at the lower-cost locations?

Answer:  Plan design.

Many employer health insurance plan designs do NOT differentiate the patient out-of-pocket cost depending on where the patient fills their prescription. Low-cost pharmacies and high-cost pharmacies have the same copay.

Of course, plan members are not going to choose lower-cost pharmacies…there is no incentive for them to.

Solution:  This problem is exactly why SimplePay Health varies prescription copays at different pharmacies. High-cost pharmacies = higher copays. Low-cost pharmacies = lower copays. 

Align plan design with desired plan member behavior. Incentives are superpowers… Let’s use them correctly.