Two federal bills have been signed into law that block insurers and pharmacy benefit managers from putting gag clauses into their contracts with pharmacies to prevent pharmacists from telling customers if they can pay less for their prescription medicines. Specifically, these bills allow a pharmacist to tell customers when they can save money by paying out-of-pocket for any prescription medicines as opposed to using their insurance and paying their fixed copayment amount. Before these bills became law, there has been no federal law banning gag clauses; several states restrict gag clauses.
Senators Susan Collins (R-ME) and Claire McCaskill (D-MO) co-sponsored S.2554 – Patient Right to Know Drug Prices Act and Senator Debbie Stabenow (D-MI) sponsored S.2553 – Know the Lowest Price Act of 2018. S.2554, which went into effect immediately, applies to individuals who either purchase their insurance on an exchange or get it through their employer. This first bill passed the Senate 98-2. S.2553 only applies to people on Medicare and will eventually mean the same thing. However, it will not go into effect until January 1, 2020. This second bill passed the Senate by unanimous consent. Both bills passed in the House on September 25, 2018.
After S.2554 was signed into law, Senators Collins and McCaskill issued a statement. Senator Collins said, “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.” Senator McCaskill said, “Earlier this year, I heard from a woman who was shocked when she found out she could get her mother’s prescription for less if she paid out of pocket than through insurance—and was even more upset her pharmacist was prohibited from telling her that was possible.” When Congress passed S.2553 in September 2018, Senator Stabenow issued the following statement: “It’s wrong that a person overpays for their medication simply because their pharmacist is not allowed to tell them they could pay a lower price with cash instead of insurance. Thanks to a successful bipartisan effort, we’ve banned this outrageous practice once and for all.”
So if you have private insurance, starting now, your pharmacist will be allowed to tell you if paying out-of-pocket will be more affordable than using your insurance. If you are on Medicare, you will still need to ask the pharmacist what the cash price would be until January 1, 2020. You can always still check what the cash price (including free coupons) would be at pharmacies by looking on WellRx.com or GoodRx.com. If you have a smartphone, both also have apps for iOS or Android devices available on iTunes or the Google Play store.