Laws Proposed to Protect Patients from Artificially High Prescription Costs

In a previous blog post, we explored “clawback” and how it affects the prices of prescriptions. In short, Pharmacy Benefit Managers (PBMs) negotiate copay prices for insurers that are often higher than the cash price paid by uninsured patients all while instituting a “gag rule” for pharmacists to forbid them from revealing the price discrepancy to patients unless asked directly. A number of states have already passed laws banning clawback and gag rules, though a group of bipartisan U.S. senators have introduced a bill the ban gag clauses for PBM-negotiated contracts nationwide.

OLYMPUS DIGITAL CAMERAA recent study by Journal of the American Medical Association (JAMA) found that 23% of all prescriptions filled through insurance ended up costing more than patients who would pay out-of-pocket. Related to this, a national poll from West Health Institute/NORC at the University of Chicago found 32% of Americans didn’t buy a prescription or took less than the prescribed dosage due to cost. This all appears to be exacerbated by the continuing rise of prescription costs; in the past 14 months well known/high-use prescriptions rose an average of 20%, while less common prescriptions rose between 100% to 1,468%.

Pharmacists reportedly feel complicit in price gouging, and are often not allowed to offer information that could save patients money. However, if a customer specifically asks for a lower price option they are allowed to provide it. With this in mind, it is always a good idea to ask your pharmacist, “Is that the best price for my medication?” to ensure you are not becoming a victim of clawback or gag clauses.

No one should have to worry about being taken advantage of or sacrificing their health due to a lack in finances. For those without any prescription coverage or those who choose not to use it to avoid clawback, the NeedyMeds Drug Discount Card saves 0-80% on the cash price for prescribed medication. A plastic card can be ordered online or requested by calling our toll-free helpline at 800-503-6897, or a printable version can be found on our website as well as the NeedyMeds Storylines smartphone app on Apple and Android devices. For those still unable to afford their medications, NeedyMeds has an extensive database of Patient Assistance Programs (PAPs) that provide prescriptions for low or no cost. NeedyMeds also has information on Coupons and Rebates that can help lower the cost of necessary medications. For more help finding information, call our toll-free helpline Monday-Friday 9am-5pm Eastern Time at 1-800-503-6897.

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