Prescription Drug Gag Clauses Nauseate Me [PHIL-OSOPHY]
President Trump signed into law a bill that will make it easier for people to find out the cost of their prescription drug. There are many cases where paying out of pocket would be much less expensive than using your insurance. Did you know this?
And the reason you probably are unaware of it is because of the pharmacy gag clauses.
Is this news to you? These gag clauses are used by insurers or pharmacy benefit managers, such as CVS Health, United Health and Express Scripts, to prevent consumers from saving money that they can pocket. Wow, what a scam!
A “pharmacy gag clause” is a tactic under which a pharmacist may not inform customers which of the two options would cost less for a certain product: using their health insurance or paying fully out of pocket.
Reports have exposed how this egregious practice has harmed consumers, such as one customer who used his insurance to pay $129 for a drug, when he could have paid $18 out of pocket.
Americans overspend by an estimated $135 on prescriptions through their insurance, in cases when they would cost less out of pocket. Yet pharmacists are often under gag orders from telling customers about that discrepancy.
President Trump’s Secretary of Health and Human Services Alex Azar related this anecdote that happened to him:
“A few years ago, my doctor back in Indiana wanted me to do a routine echo-cardio stress test…So I asked how much the test was going to cost, and was told that information wasn’t available. Fortunately, I didn’t just fall off the turnip truck, so I persisted. And eventually, the manager of the clinic appeared and gave me the answer. The list price was $5,500…
“Eventually, I was told it [what I’d pay with cash] would be $3,500…So I looked up what it would have been if I’d received it outside of the hospital, in a doctor’s office. The answer was $550…
“Now, there I was, the former deputy secretary of Health and Human Services, and that is the kind of effort it took to find out how much I would owe for a procedure. What if I had been a grandmother? Or a 20-something with a high-deductible plan?”
The new law signed by President Trump ends this practice, and it’s about time.
Phil Paleologos is the host of The Phil Paleologos Show on 1420 WBSM New Bedford. He can be heard weekdays from 6 a.m. to 10 a.m. Contact him at firstname.lastname@example.org and follow him on Twitter @PhilPaleologos. The opinions expressed in this commentary are solely those of the author.