Tag: Pharmacy Benefits Managers

Trump’s Speech on Drug Prices Boosts Pharmaceutical Stocks

President Donald Trump gave a speech about pharmaceutical drug prices last month. During his presidential campaign and leading up to his inauguration, he accused pharmaceutical companies with “getting away with murder” for what they charge patients for prescriptions and promised to enact reforms to lower drug prices. After sixteen months in office, his speech last month consisted of few proposals as opposed to proposing meaningful legislation or guidelines that could have an immediate effect on prescription costs and actually led to pharmaceutical stocks rising.

Trump took aim at Pharmacy Benefit Managers (PBMs) who he referred to as “middlemen” who implement “gag rules” that forbid pharmacists from telling patients they are spending more than they need to on a prescription (you can read our blog on the laws proposed to combat PBM gag rules here). He also touched on other popular proposals such as removing barriers to generic medications

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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.

A 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

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What is a Clawback & How it’s Affecting Your Prescription Copays

Americans may be surprised to learn that they could be paying more for their medications with their insurance copay instead of the cash price available to those without insurance. A study published last week found that Pharmacy Benefit Managers (PBMs) undermine claims that negotiated “rebates” with pharmaceutical companies are passed on to consumers. This follows a federal lawsuit filed over the summer after a California woman paid a $164 copay on a medication that can be purchased for $92 from the same pharmacy by anyone not using insurance. This practice is known as “clawback” and is instituted by PBMs who then receive the excess payments from the pharmacy.

Pharmacy Benefit Managers are being found to frequently charge a copay that exceeds a medication’s cash price for generic drugs. Moreover, pharmacists around the country are not allowed to disclose the price discrepancy to patients due to “gag clauses” in their contracts that forbid them

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Welcome to the NeedyMeds Voice! We look forward to presenting you with timely, provocative pieces on healthcare reform, patient advocacy, medication and healthcare access, and other health-related news. Our goals are to educate, enlighten, and elucidate; together, we will try to make sense of the myriad and ongoing healthcare-related changes in the U.S. today.