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Thanks to Gag Clause Laws, Pharmacists Can Now Share Price Differences with Patients



It may seem hard to imagine, but until recently, community pharmacists were prevented by contract from telling consumers if it would be cheaper to pay out of pocket for prescriptions than to bill them to their insurance. In late 2018, Congress passed a series of “Gag Clause Laws” that now permit pharmacists to tell a patient about prescription price differences. 


While it seems counterintuitive that paying the pharmacy’s “cash” price for your prescription is cheaper than your insurance-determined price, this is often the case, especially for generic medications. As you may be aware, many insurance plans have moved to high deductible plans, and especially in these cases, you may be better off asking your pharmacist about a lower-cost way to get your needed medications. High deductible plans aren’t the only place for savings, as high copays and being under-insured are places where big savings can be identified.

Additionally, many pharmacies have in-house discount programs that give you access to deep discounts on your medications. Perhaps the most understated way to save money on your medications-TALK TO YOUR PHARMACIST. Asking your pharmacist if you’re paying the lowest available price for your medications is a good start. From this conversation, in addition to identifying any available lower prices on your current medications, many pharmacists are able to provide suggestions on alternative medications that can provide similar therapeutic benefits at a lower cost.

In many instances, less expensive generic medications may serve as an appropriate alternative to a brand name medication. Your pharmacist can typically identify these recommendations and work with your prescribers to get their approval for the recommendations, whenever appropriate.

Finally, pharmacists are also experts at making “de-prescribing” recommendations. What this means, is that the pharmacist can help determine if you’re taking medications that may not be necessary and can make recommendations to your healthcare providers about possible discontinuation. Of note, never discontinue a medication without prescriber approval.

Additionally, some community pharmacies will assist patients with services like finding discount cards for brand-name medications. Also, a pharmacy should be willing and able to bill multiple insurance plans so you’re maximizing savings. Some mail order pharmacies are not able to bill secondary insurance plans, thus causing patients to experience higher costs. Additionally, the 3-month supplies often dispensed by mail order facilities can lead to waste, especially for patients who experience frequent medication changes.

If you’re currently using a pharmacy that’s not able to discuss medication pricing and potential savings with you, find a pharmacy that has this capability. Because your pharmacist has a clear picture of the cost of the medication and what you pay, they’re in the best position to make price-related recommendations about your medications, and are typically motivated to work with your prescribers for your benefit. Drug prices can change frequently, so asking anytime you’re unsure if you’re getting the best price is a good habit to be in.

Here’s hoping 2019 finds your medication costs reasonable. Talk to your pharmacist for help!

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