In a strong show of bipartisanship, the U.S. House of Representatives and U.S. Senate overwhelmingly passed two pieces of legislation at the end of September that would make it easier for pharmacists to tell patients about their payment options at the pharmacy counter.
Beginning last spring, the Arthritis Foundation led the charge by building support in Congress and among other patient and provider organizations about the importance of this legislation. The bills moved quickly through the legislative process thanks to the strength of Arthritis Foundation Advocates and Ambassadors, who called on their members of Congress to vote in favor of the legislation by sharing their stories.
How do these bills impact pharmacist gag clauses?
Both bills would ban the use of what are known as gag clauses. As we described in a previous blog post, the term “gag clause” is used to describe a section of the contract signed by a pharmacist with a health insurer or pharmacy benefit manager. This binding agreement prohibited the pharmacist from telling patients about their payment options – specifically, whether patients could save money by paying the cash price for their medication instead of using health insurance. In effect, gag clauses prevented patients from making the cheaper choice of paying out of pocket rather than a higher copayment.
The Know the Lowest Price Act, sponsored by Sen. Debbie Stabenow (D-MI), would prohibit the use of gag clauses in the Medicare program. The Patient Right to Know Drug Prices Act, sponsored by Sen. Susan Collins (R-ME), would ban the use of gag clauses in private health insurance plans and the individual insurance market.
What is the impact of this legislation on transparency at the pharmacy counter?
According to a recent study published in the Journal of the American Medical Association, patient overpayments for medication represented nearly 25 percent of more than 10 million prescription claims analyzed. In addition, the passage of these bills means that the tens of millions of Americans who receive health coverage through their employer or obtain health insurance on the individual market will be able to learn more about payment options at the pharmacy when there is a difference between the cost of the drug under the health plan and the cash price. It also means the millions of people accessing prescription drugs under Medicare can also learn about these differences.
What’s next? How do I benefit from this legislation?
The president supports the legislation and signed it into law on October 10, but here are three steps you can take right now to ensure that you and those with chronic diseases benefit from this legislation:
- Don’t be afraid to ask your pharmacist if it would be cheaper to pay for your medication out of pocket rather than a copayment under your health insurance. Know that pharmacists must now tell you whether there is a difference between those two forms of payment.
- Just because these federal bills made it to the president’s desk doesn’t mean the work stops there. State legislation banning the use of gag clauses is also needed to ensure that people enrolled in Medicaid and certain other state-regulated plans can have transparency at the pharmacy counter, too. To get involved, reach out to your state advocacy team member here to learn more.
- Finally, it’s important to take a few moments and say thank you to your member of Congress for recognizing the need for more transparency at the pharmacy counter. Head over to our advocacy Action Center and send a note!
Let’s celebrate this federal legislative victory for people with arthritis and other chronic diseases. Patients shouldn’t have to pay more out of pocket for medication at the pharmacy counter simply because they didn’t ask the right questions. Want to get more involved? Consider signing up to be an Arthritis Foundation Advocate! Becoming a part of our advocacy grassroots network is an easy way to take action and stay informed.