Report: Senators take aim at pharmacy “gag clauses”

A bipartisan group of senators introduced two bills this week to stop “gag clauses” – conditions that prevent pharmacists from telling customers when they could save money on a prescription if they paid out of pocket rather than using insurance.

These clauses are sometimes included in the contracts inked between the various parties that dictate drug pricing for Americans – pharmacies, insurers and prescription benefit managers.

Sens. Susan Collins (R-Maine), Claire McCaskill (D-Mo.), Debbie Stabenow (D-Mi.), Bill Cassidy (R-La.) and John Barraso (R-Wyo.) introduced the “Patient Right to Know Drug Prices Act” bill, which applies to plans offered through exchanges and by private employers.

“Insurance is intended to save consumers money. Gag clauses in contracts that prohibit pharmacists from telling patients about the best prescription drug prices do the opposite,” Collins said in a statement.

“Multiple reports have exposed how this egregious practice has harmed consumers, such as one customer who used his insurance to pay $129 for a drug when he could have paid $18 out of pocket. Americans have the right to know which payment method – insurance or cash – would provide the most savings when purchasing prescription drugs,” she added.

The same group of senators, joined by Sen. Ron Wyden (D-Ore.), also introduced the “Know the Lowest Price Act of 2018” bill, which would grant the same benefit to Medicare Part D beneficiaries.

Researchers reviewing 9.5 million insurance claims reported this week that nearly 25% of prescriptions filled through insurance resulted in patients spending more than they would have if they paid in cash.

The National Community Pharmacists Association applauded the senators’ efforts, saying that the bills could free up pharmacists to give customers the best possible price-point for their prescriptions.

“Some practices of pharmacy benefit managers can inhibit the ability of pharmacists to assist patients in finding the lowest price for prescription drugs,” NCPA CEO B. Douglas Hoey said in a statement emailed to Drug Delivery Business News.

“This issue is symptomatic of a broader problem related to anticompetitive PBM practices, which lack transparency, add cost and endanger patient access to pharmacy services. We encourage Congress to continue their focus on reforming the drug middlemen. NCPA is ready to assist those efforts in any way possible.”

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