As we all know, the cost of prescription medications can be outrageous. Disease-modifying therapies aside, even with insurance, the medications we get from a pharmacy can take quite a bite out of a budget.
Though many people don’t know it, there are times when it can actually be cheaper to pay for a therapy out-of-pocket than to have your insurance pay for it. But it’s not always easy to compare prices. In fact, there are actually “gag clauses” in some of the agreements that pharmacies have with insurance companies and prescription benefit managers. These clauses prohibit pharmacists from proactively telling you about potential savings.
On Capitol Hill, however, a bipartisan group of senators has introduced a pair of bills that would gag the gag clauses. Sen. Susan Collins, R-Maine, is one of three Republicans and two Democrats who are sponsoring the measures. (The co-sponsors are Sens. Claire McCaskill, D-Mo., Debbie Stabenow, D-Mich., John Barrasso, R-Wyo., and Bill Cassidy, R-La.
In a news release, Collins pointed out that one customer who used his insurance paid $129 for a medication. If he’d paid for it out-of-pocket, however, it would have cost him only $18.
“Your pharmacist should be able to tell you if there’s a cheaper way to get the prescription drugs you need,” Collins said. “It’s outrageous that current practice prevents that, and our bipartisan bill would change it.”
A recent study that reviewed 9.5 million insurance claims found that 23 percent of prescriptions filled through insurance ended up costing customers more than if they had paid for the medicine out-of-pocket. The overpayments totaled $135 million for 2013, or an average of $10.51 per covered member. The Journal of the American Medical Association published the study.
The Patient Right to Know Drug Prices Act and the Know the Lowest Price Act would prohibit health insurers and pharmacy benefit managers from using those pharmacy gag clauses. The first bill would prohibit an insurer or a pharmacy benefits manager from restricting a pharmacy’s ability to provide drug price comparisons to someone who is covered by an insurance plan. The Know the Lowest Price Act would provide this same protection for people covered by Medicare Advantage and Medicare Part D plans.
This pair of bills is just beginning to make its way through the legislative process. Let’s keep an eye on them. These are two bills that we, as patients, can support no matter what our political party is.
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