Pharmacy ‘Gag Clauses’ May Keep You from Getting the Lowest Rx Prices

You might believe that using your insurance is the best or the only way to pay for prescription medications. So, it may come as a surprise to learn that sometimes paying out of pocket rather than through your health plan is cheaper.

Last Wednesday, President Trump signed two bills into law that ban pharmacy gag clauses. The two bills, “Patient’s Right to Know Drug Prices Act” and the “Know the Lowest Price Act,” are intended to help consumers find out how they can pay less for prescription drugs. “Citizens deserve to know the lowest prices available at our pharmacies” Trump said at a ceremony at the White House last week.

A March 2018 study found that 1 in 5 prescriptions required people to pay more for their medication with insurance than what they would if they paid the pharmacy’s retail price.

The system involving how prescription drugs are paid for is complex, involving pharmacy benefit managers (PBMs), companies that act as the middlemen for drug makers, insurers and drugstores. These entities, as well as insurers, would use “gag clauses” in their contracts to forbid pharmacists from sharing information with consumers on how they could save money if they didn’t go through their health plans. In some cases, pharmacists could have been dropped from insurance networks or fined if they violated these contracts.

Under the new rules signed into law, pharmacists aren’t obligated to tell you about a lower cost but cannot be forced to keep quiet when it’s cheaper to buy medication without using insurance.

Consumer Reports recommends not waiting for your pharmacist to tell you when you might be able to save. Instead, here are some questions to ask your pharmacist to help get the best price on your prescriptions:

  1. Is there a generic version of my medication? Generic drugs use the same active ingredient as branded drugs and are regulated by the Food and Drug Administration in the same manner. Using generic versions of branded drugs could save you up to 85 percent off the price.
  2. Will a 90-day prescription save me money? You may be able to avoid paying one or even two co-pays if you get a three-month supply of your medication.
  3. Do you offer any discounts? Many major chain pharmacies offer dozens of common generics at a discount if you don’t pay with your insurance.

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