There Might Be a Cheaper Drug, But Pharmacists Can’t Tell You That
A few months ago,
That would be unremarkable, except for what happened next. Kennedy had a friend behind the pharmacy counter where he went to fill the prescription. The pharmacist-friend said he would charge Kennedy the retail price for the small drug dose he needed, without going through his insurance company, because the retail price was cheaper than the insurance copayment.
Kennedy won't name his friend because the pharmacist might have violated a "gag clause" in the store's contract with a pharmacy benefit management company that handles its drug insurance plans.
Instead, Kennedy and four colleagues, all
Lawmakers from at least 30 states considered bills on pharmacy benefits managers this year. Many of the measures would eliminate the so-called gag rule, according to the
Legislators were motivated to act on the issue "because it affects the ordinary consumer," said
"As a consumer you would have no idea how this works," he said. "Even if you were aware of the issue, it would be hard to know when the person across the counter says, 'This is
Cauchi said the rapid spread of bills among state legislatures is remarkable. "States are sovereign entities; they don't work in tandem. It's notable," he said.
Many consumers know of pharmacy benefit management companies through their brand names, such as
The gag clauses are inserted into contracts with pharmacies by pharmacy benefit management companies, and they prohibit druggists from telling patients or caregivers about lower prices or cheaper drug options, such as generic drugs. Patients never know that there could be a less expensive way to get their medicines, because their neighborhood pharmacist can't talk about it lest she violate those contracts.
States have been leading the fight against the gag clauses, although President
Kennedy said he's "heard from constituents who have run into this problem, and in many cases, I don't think they are fully aware. It's not until after the fact that they think about it, particularly the senior citizens."
Pharmacist
"There's no other profession in the world where you can't tell your customer how to best utilize their money," he said.
Independent pharmacies are leading the charge against the gag rules, because unlike the big chains, they are not corporately intertwined with the pharmacy benefit managers.
He said most of his members are afraid to speak to the media or anyone else about the situation because they are concerned they will "get kicked out of the network" of insurance companies.
"It could be the end of their business," he said. "They are just too scared to talk about it. But the situation is real."
Pharmacy benefit managers such as
But the companies also don't want to be restricted.
In February, the
"We support the patient always paying the lowest cost at the pharmacy counter, whether it's the cash price or the copay," the group statement said.
State Rep.
"They weren't disclosing it to the customer, but they were disclosing it to me and other legislators," he said in an interview. "They argued, 'We have to have formularies, we have to be able to control them, that's how we manage costs,'" he said, referring to lists of covered drugs and prices.
But, Keiser said, compared with the examples of cheaper prices provided to the lawmaker off the record by pharmacists, "it was clear that was not in the best interests of the consumer."
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