Lawmakers have sights on middlemen blamed for rising drug costs | TheHill

With public outrage growing over the rising costs of prescription drugs, Congress is targeting the middlemen they say are to blame.

Specifically, lawmakers are moving to ban “gag clauses” that prohibit pharmacies from telling customers they can save money on a drug if they pay with cash instead of using their health insurance.

These clauses are sometimes included in contracts between pharmacies and pharmacy benefit managers — the middlemen who act as negotiators between drug companies and insurers.

The clauses prevent a pharmacist from telling a customer if their $20 co-pay is higher than the pharmacy’s cash price for a drug.
“Pharmacists want to be able to give their consumers information about what’s the best way to buy the medication they need, but the gag rule prohibits the pharmacists from doing that,” said Rep. Peter Welch (D-Vt.), co-sponsor of a House bill that would ban gag clauses.

The practice of charging a co-pay that is higher than the cash price of a drug is called a “clawback.”

The National Community Pharmacists Association (NCPA), one of the groups pushing for a federal “gag clause” ban, notes that it’s the pharmacy benefit managers or “PBMs” that keep this extra money, not the pharmacies.

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Lawmakers have sights on middlemen blamed for rising drug costs | TheHill.