Pay Less for Drugs by Asking One Simple Question
Get Legal Help Today
Secured with SHA-256 Encryption
UPDATED: Apr 7, 2018
It’s all about you. We want to help you make the right legal decisions.
We strive to help you make confident insurance and legal decisions. Finding trusted and reliable insurance quotes and legal advice should be easy. This doesn’t influence our content. Our opinions are our own.
Editorial Guidelines: We are a free online resource for anyone interested in learning more about legal topics and insurance. Our goal is to be an objective, third-party resource for everything legal and insurance related. We update our site regularly, and all content is reviewed by experts.
You might be able to pay less for prescription drugs — but your pharmacist might not be allowed to tell you that.
As the New York Times reports,
As consumers face rapidly rising drug costs, states across the country are moving to block “gag clauses” that prohibit pharmacists from telling customers that they could save money by paying cash for prescription drugs rather than using their health insurance.
According to Kaiser Health News, patients overpay for prescriptions 23% of the time.
Consumers may not realize that the cash price for some prescriptions can be less than the co-pay under their insurance.
A study at USC showed that the average overpayment by consumers was $7.69 per prescription. Some consumers were over-paying as much as $20 for some of the common drugs studied.
As the National Conference of State Legislators notes,
Commercial contracts between a pharmacy and a Pharmaceutical Benefit Manager (PBM) are a widespread feature in the distribution and sales chain between [the] original manufacturer and the end consumer.
A PBM is a third-party administrator of a prescription drug program for health plans, including federal and state government health plans.
According to the American Pharmacists Association (APhA),
PBMs are primarily responsible for developing and maintaining the formulary [list of medicines], contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims. For the most part, they work with self-insured companies and government programs striving to maintain or reduce the pharmacy expenditures of the plan while concurrently trying to improve health care outcomes.
PBMs manage pharmacy benefits for about 266 million Americans — about 82% of the US population.
Sales of pharmacy and mail-order consumer purchases of prescription drugs in the US total more than $235 billion per year.
According to Kaiser Heath,
The practice of charging a copay that is higher than the full cost of a drug is called a “clawback” because the middlemen that handle drug claims for insurance companies essentially “claw back” the extra dollars from the pharmacy.
A growing number of state legislatures are moving to prohibit the gag clauses.
For example, a North Dakota law bans gag orders and says that a pharmacist “may include the cost and clinical efficacy of a more affordable alternative drug if one is available.”
North Dakota also prohibits charging a co-pay that’s more than the cost of a prescription.
As the Times reports,
At least five states have adopted laws to make sure pharmacists can inform patients about less costly ways to obtain their medicines, and at least a dozen others are considering legislation to prohibit gag clauses, according to the National Conference of State Legislatures.
How to Save Money
Even where a gag clause exists prohibiting a pharmacist from volunteering that a drug is cheaper if bought with cash, consumers can still ask and pharmacists aren’t prevented from giving them an honest answer.
So you may be able to save money the next time you go to the pharmacy — just by asking a simple question.