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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·普西不得不保持缄默，因为顾客以为他们的保险能帮他们买到便宜的药物，
cough up co-payments for generic medications that are far higher than the out-of-pocket costs.
购买保险后支付的费用比现付成本还要高。
Pusey's contracts with pharmacy benefit managers (PBMs)—
普西与药品利益管理机构-
the influential companies that administer prescription drug plans on behalf of insurers and large employers—
代表保险公司和大型雇主执行处方药计划的有影响力公司的条约中规定
bar him from volunteering details of their deals.
普西不得提供交易的细节。
In fact, for some generic medicines, co-pays do cost more than if a patient skipped insurance and paid for the drug directly.
事实上，对于一些非专利药物来说，这样确实比患者不购买保险直接支付的费用要高。
Pusey can tell people only if they ask—though they often don't like his reply.
普西只有在别人问的时候才会说——尽管普西的回答并不受欢迎。
"Some of them get fired up," says Pusey, who owns the Medi-cap Pharmacy in Olyphant, Pennsyl-vania.
“一些人很生气，”在宾夕法尼亚州的奥利凡特拥有医疗帽药店的普西说。
"Some of them don't believe what we're telling them is accurate."
“他们中的一些人认为我们说的不是真的。”
The extra money—as little as $2 or as much as $30 a prescription—goes into the pockets of the PBMs.
一份处方多出来的钱——低至2美元或多至30美元——进入了药品利益管理机构的口袋。
In the drug industry, these higher co-pays on cheap generics are called clawbacks,
在制药行业，对廉价非专利药物的共同支付被称为回扣，
and they can mean millions of dollars for the PBMs on a highly marked-up drug.
这意味着对于标记药品来说，药品利益管理机构能够得到数百万美元。
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.
病人去药房支付费用——大概15美元——由药品利益管理机构和雇用药房的保险公司商定。
The pharmacy gets reimbursed for the price of the drug, say $2, and a small profit.
药房报销药品的价格，比如2美元，得到小额利润。
Then the benefit manager "claws back" the remainder.
剩余部分由药品利益管理机构“拿回”。
