Pharma won’t tell you that you can pay less for drugs — Sen. Collins is fighting to change that
This month, Congress sent the Patient Right to Know Drug Prices Act and the Know the Lowest Price Act of 2018 to President Trump’s desk for signature. These bills, which were sponsored by Sens. Susan Collins (R-Maine) and Debbie Stabenow (D-Mich.), help protect Medicare patients and those with private insurance from overpaying for prescription drugs by outlawing pharmacy “gag clauses.”
In some cases, a patient’s copayment may be more than the cost of a prescription medication, making it less expensive for patients to pay cash for the drug than to use insurance. Gag clauses are agreements between health plans or pharmacy benefit managers and pharmacies that allow pharmacies not to disclose that customers they can save money by paying for their medicines out-of-pocket.
Sen. Collins, who is the chairwoman of the Senate Aging Committee and serves on the Senate Health Committee, has worked with colleagues on both sides of the aisle to investigate causes of the high costs of prescription drugs and propose solutions to enhance their affordability and accessibility. The bans on gag clauses passed overwhelmingly with bipartisan support.
Nobody knows for sure how often patients pay their insurers more in copayments than the costs of their medicines. The Pharmaceutical Care Management Association, a trade organization that represents pharmacy benefit managers, is on record as opposing gag clauses but claims they are rare.
However, a University of Southern California study released this year suggests it may be common. In 2013 the authors found that nearly a quarter of pharmacy prescriptions involved a copayment that was greater than the average sale price of the drug. These overpayments are also known as “clawbacks.”