Each legislative session thousands of bills and amendments are introduced in the Pennsylvania Legislature. Only a fraction become law, and an even smaller portion receive wide media coverage.
These bills impact the lives of people living in Pennsylvania every day. Each week The Sentinel will highlight one bill that has not received widespread attention.
About the bill
When you pick up your prescription medication, the pharmacist asks if you have insurance, tells you your co-pay and asks for your payment. It sounds straightforward, but you may be losing money.
Particularly in the case of generic drugs, it may be that you could have saved by purchasing the drug directly from the pharmacy at a lower cost than your health insurance co-pay.
But your pharmacist didn’t tell you that. Perhaps he or she legally couldn’t.
Pharmacies sign contracts with pharmacy benefit managers, companies like Express Scripts, CVS Health and OptumRx that administer the prescription drug portions of health insurance plans. These contracts sometimes contain “gag clauses” that restrict what pharmacists can tell their patients.
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“Language essentially prohibits pharmacists from disclosing any information to their customers that could potentially reduce their out-of-pocket costs for medications,” state Rep. Valerie S. Gaydos, R-Moon Township, said in a co-sponsorship memo. “For instance, for many less expensive, generic medicines, co-pays can often be more expensive than if the patient simply pays out-of-pocket and bypasses insurance.”
One survey found that at least 20 percent of pharmacists are frequently affected by gag clauses, according to the Associated Press.
Gaydos introduced legislation designed to effectively eliminate the practice by banning contracts from containing language that prohibits pharmacists from discussing information concerning the cost of a drug with a patient. House Bill 943 would also ban the practice of preventing pharmacists from “disclosing the availability of therapeutically equivalent alternative medications or selling to the covered individual a more affordable alternative if an affordable alternative is available,” according to the text of the bill.
In recent years, “gag clauses” have faced bipartisan opposition. At least 16 states have already passed laws regulating PBMs, according to Kaiser Health News. Congress also passed a law in October banning gag clauses for nationwide contracts and contracts involving Medicare Part D.
The Pennsylvania bill unanimously passed the House Health Committee in June and is sitting in the House Rules Committee.
In the meantime, experts recommend shopping around at different pharmacies and directly asking the pharmacist about the out-of-pocket cost of the medication, which can in many cases free the pharmacist to discuss it.