Your Insurance Copay Is a Scam (Proof: $7 vs $25)

Here's something your insurance broker doesn't want you to know. A 90-day supply of Lisinopril — a common blood pressure medication — costs $7.67 at Cost Plus Pharmacy. Through insurance? $25.00. Same drug. Same dose. Same 90 days. Your copay isn't a discount. It's often more than the actual cash price.

What's Really Driving Up Your Drug Costs?

The culprit is a hidden layer in the pharmacy system called a pharmacy benefit manager (PBM). PBMs sit between your insurance company and the pharmacy. They negotiate drug prices — but they also take a cut. That cut gets baked into what you pay at the counter.

Mark Cuban's Cost Plus Pharmacy cuts PBMs out entirely. It buys drugs directly and sells them at cost plus a small markup. The result? Prices that are often 50–80% lower than what you'd pay using insurance.

And it's not just Lisinopril. Common generics — cholesterol medications, blood pressure drugs, diabetes medications — are dramatically cheaper when you skip the insurance middleman altogether.

This Is the Bigger Problem With Traditional Insurance

The pharmacy example is just one piece of a much larger pattern. Traditional group insurance is built on inflated prices and hidden markups. Big insurance carriers — Blue Cross, United, Cigna, Aetna, Humana — negotiate "discounts" off prices that were already inflated to begin with. It looks like a deal. It isn't.

High premiums. Copays that cost more than cash prices. Deductibles employees never meet. This is what small business owners are paying thousands of dollars a month to provide.

There's a Smarter Way to Handle Employee Benefits

Small business owners don't have to keep overpaying for group coverage. Two better options exist right now.

ICHRA — Let Employees Choose Their Own Coverage

An Individual Coverage Health Reimbursement Arrangement (ICHRA) lets you set a fixed monthly contribution for each employee. Employees use that money to buy their own individual health insurance — a plan that fits their needs, not a one-size-fits-all group policy.

You control the cost. Employees get real choices. And unlike traditional group plans, there's no minimum or maximum on what you can contribute. You set the number that works for your budget.

Indemnity Plans — Reward Employees Who Shop Smart

Employees who opt out of the ICHRA can access an employer-sponsored indemnity plan instead. These plans have no deductibles and no copays. Instead, they pay a set benefit amount for covered services.

Here's where it gets interesting. When an employee finds a lower-cost provider — say, a cash-pay clinic or a direct-pay doctor — and the bill is less than the benefit amount, the employee keeps the difference. That's a real financial incentive to shop around and negotiate. When employees do that, healthcare costs go down for everyone.

The employer's defined contribution carries over to the indemnity option. If the indemnity premium is less than the contribution amount, the employee pays nothing out of pocket.

Stop Paying More for Less

If a $7 prescription costs $25 through insurance, what does that tell you about everything else you're paying for? Small business owners deserve a benefits strategy that actually works — one that controls costs, gives employees real value, and doesn't funnel money to middlemen.

Ready to explore a smarter approach to employee benefits? Visit benefitx.com to learn how The Benefit X-Change can help your business offer affordable, flexible health benefits in 2026.