Were you aware that until recent legislation was passed this month, pharmacists were prevented from telling consumers they could purchase their prescription for a lesser cost than their applicable copayment under their insurance plan? This ‘gag’ order prevented pharmacists from revealing to patients that a lower cost purchase option was available. This was permissible due to provisions in their contracts with the influential companies that manage drug benefits for insurers and employers. The clauses forced the pharmacists to remain silent as, for example, a consumer pays $100 under his insurance plan for a drug that would have cost $75 if purchased with cash.
Two bills were signed by President Trump on October 10th to assist consumers in knowing what their lowest cost would be for a prescription drug, the Know the Lowest Price Act and the Patients’ Right to Know Drug Prices Act. Both prevent “gag clauses” in agreements between pharmacy benefit managers and pharmacies. Pharmacy benefit managers are the middlemen who control and administer prescription drug programs for insurance companies.
Though pharmacists are not required to tell patients about the lowest cost options, they are no longer prevented from informing patients under this new legislation.
Please keep this in mind the next time you fill a prescription. Ask the pharmacist if your copay is the lowest cost you would pay for the drug. You may be able to purchase it for a lower cost than your prescription copay.