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‘Gag Clauses’ and Prescription Drug Prices – Consumer Reports

Consumer Reports – “When you fill a prescription at your local drugstore, you probably assume that using your insurance is the best—maybe even the only—way to pay. So you might be surprised to learn that you can sometimes pay less if you don’t use your insurance. And there’s a good reason that counterintuitive cost-saving strategy isn’t widely known. Pharmacists are often bound by “gag clauses” in contracts with pharmacy benefit managers (PBMs)—companies that act as go-betweens for drugmakers, insurers, and drugstores—from sharing that information. Gag clauses are particularly worrisome given the results of a March 2018 study in JAMA – Overpaying for Prescription Drugs: The Copay Clawback Phenomenon. It found that for one in five prescriptions, insurers required people to pay more for their medication with insurance than what they would if they simply paid the pharmacy’s retail price. The good news is that there’s a simple way to get past the problem of gag clauses. Just ask a pharmacist “how much would you charge me if I didn’t use my insurance,” says Victor Curtis, R.Ph., senior vice president of pharmacy for Costco. That allows him or her to have a candid conversation with you about the price of your medication..” [h/t Pete Weiss]

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