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House passes bills prohibiting pharmacy gag clauses on drug prices | Healthcare Finance News


On Tuesday, the U.S. House of Representatives unanimously passed two bills that would prevent pharmacy benefit managers from putting gag clauses into contracts with pharmacies. The gag clauses restrict the pharmacist from telling customers they could pay less for a prescription if they paid the full price of the drug out-of-pocket rather than using their insurance and paying the copay amount.

The Patient Right to Know Drug Prices Act applies to group plans sponsored by employers and plans offered in the individual market.

The Know the Lowest Price Act applies to Medicare Advantage and Medicare Part D plans.

Both bills passed the Senate unanimously earlier this month and are headed to the President Trump’s desk to be signed into law.  The President has expressed his support for the legislation.


Beyond consumers paying more than necessary, the practice costs the Centers for Medicare and Medicaid Services money. Earlier this year, CMS Administrator Seema Verma sent a letter to all Medicare Part D plan sponsors telling them the agency’s existing policy requires them to ensure enrollees pay the lesser of the Part D negotiated price or copay, or be subject to CMS compliance actions.

Also, Part D plan sponsors must tell their network pharmacies to disclose the price of the lowest cost generic version of the drug.

This was part of the president’s plan to promote drug price transparency in his blueprint unveiled in May, Verma said.

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House passes bills prohibiting pharmacy gag clauses on drug prices | Healthcare Finance News.

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