The Pennsylvania Senate is entertaining a bill that would, among other things, prevent pharmacy benefit managers from imposing gag clauses on pharmacists.
SB 637 would prevent PBMs from putting gag clauses in their contracts with pharmacists. The bill was introduced in April 2017, and reintroduced in December 2017. Currently, the bill is in the Appropriations committee. In part, the bill reads:
"(E) PHARMACY BENEFIT MANAGER OR INSURER CONTRACTS WITH PHARMACIES MAY NOT CONTAIN A PROVISION THAT PROHIBITS PHARMACISTS FROM DISCLOSING INFORMATION TO A CUSTOMER THAT WOULD REDUCE THE CUSTOMER'S OUT-OF-POCKET COSTS FOR PRESCRIPTION DRUGS."
Pharmacy benefit managers can tell your pharmacist what to say - and it could cost you money.
Currently, some pharmacists are not able to tell patients when they could be paying less for their medications because PBMs put gag clauses in their contracts. PBMs sometimes set the copay price of a drug (what you pay if you used insurance) higher than the list price of the drug (the price you pay without using insurance). When insurance companies do this price setting, it is called a "clawback." Gag clauses order a pharmacist not to tell you about the clawback, so they cannot say if you could pay less for a drug if you did not use your insurance. This results in higher prices for the patient. This practice is especially detrimental for people with diabetes because they pay about 2.3 times more on healthcare than people without diabetes. Gag clauses are surprisingly widespread; some independent pharmacists estimate that if they were allowed, they could have saved their patients money in about 10% of transactions. DPAC has done a deep dive into gag clauses on our blog.