October 12, 2018
President Trump signed the Patient Right to Know Drug Prices Act (S.2554), which prohibits an insurer or pharmacy benefit manager from restricting a pharmacy’s ability to tell consumers when their insurance copay is higher than the cash price for a drug.
The new law applies to employer health plans as well as individual plans sold on and off the ACA exchanges. A companion bill (S.2553) that was also signed by the President bars gag clauses in Medicare Advantage and Part D plans.
A recent Journal of the American Medical Association study found 23 percent of prescriptions cost more to patients if they were filed through their insurance instead of paid out-of-pocket.
Takeaway: Employers should work with their pharmacy benefit manager, third-party providers, and carriers to ensure there are no gag clauses in their contracts.