COLUMBUS (WCMH) — If you use your health insurance when picking up prescriptions you might be paying too much for your medication, and the pharmacist can’t even tell you it is happening.

That’s because Pharmacy Benefit Managers, a middleman between pharmacies, insurance companies and pharmaceutical companies has placed gag orders into the contracts they have with pharmacists.

Pharmacists claim to have been threatened with a loss of contracts if they break the PBM gag order.

Here’s basically how it works according to State Representatives Scott Lipps and Thomas West: Chlorthalidone, which is commonly used to treat high blood pressure, costs $72.05 if it is purchased without using insurance. However, if insurance is used one the PBM negotiated price is $92.36; this results in a customer overcharged of about $20.

According to the lawmakers, none of money that is overcharged goes to the pharmacist. That’s because after the customer pays the $92.36 the PBM takes $47.62 as its cut in a clawback from the pharmacy and leaves $44.74 that becomes the pharmacy’s net payment.

Because the medication’s regular cash cost is $72.05, the pharmacy effectively lost more than $27 on the transaction. That $27 plus the $20 overcharged to the customer means the PBM pocketed $47.62 at their expense.

Another example the lawmakers shared was this: a drug commonly used for the prevention and/or treatment of heart or chest pain, and for the treatment of high blood pressure has a Regular Cash price of $11.45, but when customers use their insurance they are instead charged $29.17 resulting in an overcharge of $17.72.

The PBM then takes a $27.99 clawback on the transaction, leaving the pharmacy with $1.18 and a loss of $10.27 they would have had if the customer did not use their insurance in the first place.

To be clear, this does not happen on with every prescription.

According to Antonio Ciaccia with the Ohio Pharmacists Association, a recent study conducted by the Journal of American Medical Association of 9.5 million prescriptions found roughly 23% of them resulted in the customer being overcharged in this way, or nearly 1 in 5 prescriptions.

“As a consumer, we are very much powerless in this entire transaction,” said Ciaccia.

Lipps and West hope to remedy that with their legislation which would remove the gag orders and clawbacks.

The bill is one of several that are looking into PBM practices here in Ohio. It is expected to continue to get hearings as the other bills progress, however, there is a limited amount of time left in this general assembly and if the bills do not complete their legislation journey by the end of December they will have to be re-submitted in the next one and start the process all over again.

In the meantime, we are all left wondering if we are paying the best price for our medication or if we’re getting ripped off.