As consumers face rapidly rising drug costs, states across the country are moving to block “gag clauses” that prohibit pharmacists from telling customers that they could save money by paying cash for prescription drugs rather than using their health insurance, reports the The New York Times, February 24.
Here’s how the pricing works: A consumer filling a prescription for a drug to treat diabetes or high blood pressure may owe $20 if he uses insurance coverage. By contrast, a consumer paying cash might have to pay $8 to $15.
“Many West Virginia pharmacists have expressed frustration about provisions in their contracts with the powerful pharmacy benefit managers (PBMs). The gag clauses in the PBM contracts force pharmacists to remain silent when, for example, a consumer pays $125 under their insurance plan for an influenza drug that would have cost $120 if purchased with cash,” said Richard Stevens, Executive Director of the West Virginia Pharmacists Association. The statewide organization is supporting Senate Bill 46 in the West Virginia Legislature which would prohibit the gag clauses.
At least five states have adopted laws to make sure pharmacists can inform patients about less costly ways to obtain their medicines, and at least a dozen others are considering legislation to prohibit the gag clauses, according to Stevens.
WVPA is following a new Georgia law which says a pharmacist may not be penalized for disclosing such information to a customer. Maine has a similar law.
Pharmacy benefit managers say they hold down costs for consumers by negotiating prices with drug manufacturers and retail drugstores, but their practices have come under intense scrutiny. The White House Council of Economic Advisers said in a report this month that large pharmacy benefit managers “exercise undue market power” and generate “outsized profits for themselves.”
