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Eric Pusey has to bite his tongue when his pharmacy's customers, thinking their insurance is getting them a good deal,
埃里克·普西不得不保持緘默，因為顧客以為他們的保險能幫他們買到便宜的藥物，
cough up co-payments for generic medications that are far higher than the out-of-pocket costs.
購買保險后支付的費用比現付成本還要高。
Pusey's contracts with pharmacy benefit managers (PBMs)—
普西與藥品利益管理機構-
the influential companies that administer prescription drug plans on behalf of insurers and large employers—
代表保險公司和大型雇主執行處方藥計劃的有影響力公司的條約中規定
bar him from volunteering details of their deals.
普西不得提供交易的細節。
In fact, for some generic medicines, co-pays do cost more than if a patient skipped insurance and paid for the drug directly.
事實上，對于一些非專利藥物來說，這樣確實比患者不購買保險直接支付的費用要高。
Pusey can tell people only if they ask—though they often don't like his reply.
普西只有在別人問的時候才會說——盡管普西的回答并不受歡迎。
"Some of them get fired up," says Pusey, who owns the Medi-cap Pharmacy in Olyphant, Pennsyl-vania.
“一些人很生氣，”在賓夕法尼亞州的奧利凡特擁有醫療帽藥店的普西說。
"Some of them don't believe what we're telling them is accurate."
“他們中的一些人認為我們說的不是真的。”
The extra money—as little as $2 or as much as $30 a prescription—goes into the pockets of the PBMs.
一份處方多出來的錢——低至2美元或多至30美元——進入了藥品利益管理機構的口袋。
In the drug industry, these higher co-pays on cheap generics are called clawbacks,
在制藥行業，對廉價非專利藥物的共同支付被稱為回扣，
and they can mean millions of dollars for the PBMs on a highly marked-up drug.
這意味著對于標記藥品來說，藥品利益管理機構能夠得到數百萬美元。
Here's how clawbacks work:
下面是回扣的方式：
A patient goes to a pharmacy and pays a co-pay amount—perhaps $15—agreed to by the PBM and the insurers who hire it.
病人去藥房支付費用——大概15美元——由藥品利益管理機構和雇用藥房的保險公司商定。
The pharmacy gets reimbursed for the price of the drug, say $2, and a small profit.
藥房報銷藥品的價格，比如2美元，得到小額利潤。
Then the benefit manager "claws back" the remainder.
剩余部分由藥品利益管理機構“拿回”。
