Sending Office: Honorable Earl L. “Buddy” Carter
Currently, pharmacists are prevented from telling their patients about a lower-cost, out-of-pocket option rather than utilizing insurance coverage, which may have a higher pricetag. These ‘gag clause’ provisions are included in provider manuals
and contracts which require broad confidentiality agreements for pharmacists. Often, these contracts offered by the pharmacy benefit manager (PBM) are a take-it-or-leave-it situation where the pharmacist doesn’t have alternatives available to them. If they
opt not to take the contract, they are often left out of servicing large segments of the patient market. While PBMs continue to advocate that they don’t participate in this practice, it continues to occur. The Prescription Transparency Act would address the
priorities set out by the Administration to lower drug prices and to reduce the burden on millions of Americans at the drug counter.
This legislation would prohibit gag orders from being included in any contractual agreements between pharmacy benefit managers, or health insurance carriers, and a pharmacist or their contracting agent. It states that any provision included in a contractual
agreement between these parties meeting the defined parameters would be considered null-and-void and would allow the pharmacist to properly advise their patients on lower-cost opportunities.
Examples of Gag Clause Provisions:
Confidentiality: Provider acknowledges and agrees that in the performance of services hereunder, Provider will comply with the Confidentiality provisions set forth in the Provider Manual and as set forth in this Agreement.
Contacting Sponsors or Media: Provider hereby agrees (and shall cause its affiliates, employees, independent contractors, shareholders, members, officers, directors and agents to agree) that it shall not engage in any conduct or communications,
including, but not limited to, contacting any media or any Sponsor and/or Sponsor’s Members or other party without the prior consent of [PBM].
Example of Gag Clause Effects:
A patient filling a prescription for a blood pressure drug may have to pay $30 if they utilize their insurance coverage. If they were to pay out of pocket, the cost of that drug may now be $12. However, pharmacists cannot advise their patient that it is
an option for fear of legal repercussions or being blacklisted from future opportunities.
States Prohibiting Gag Clauses: Arkansas, Connecticut, Georgia, Maine, Minnesota, Nevada, North Dakota, North Carolina
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