Your prescription drugs could be cheaper than your pharmacist is telling you — but your pharmacist may not have the option to say so.
A Missouri bill before a House committee targets gag clauses that prevent pharmacists from telling patients when the cash price for a drug is less than the insurance price. The bill will be heard Tuesday by the House Insurance Policy Committee.
The gag clauses are contracts between pharmacies and pharmacy benefit managers, who work as intermediaries between insurance companies and pharmacies to manage prescription drug programs.
The bill’s sponsor Rep. Lynn Morris, R-Nixa, said he has seen the effects of these orders in his own pharmacy. He said the bill is critical for the entire state because it would create a transparent system and ensure the best price for the customer.
“If you could pay a cash price that was lower than the insurance price, you’d be happy to do it,” Morris said. “But we can’t disclose it first.”
If customers ask whether the cash price would be cheaper, pharmacists are free to tell them, but consumers don’t always know to ask.
“Basically, we are filling prescriptions every day that cost consumers more money,” Morris said.
Ann Bromstedt, vice-president and co-owner of Kilgore’s Medical Pharmacy in Columbia, said gag clauses are unfair to customers and jeopardize her ability to provide the best care for her customers. She doesn’t know if the bill will pass but sees it as a step toward more transparency.
“Then we’re allowed to be honest with our patients,” Bromstedt said. “We’re allowed to advocate harder for our patients and be more diligent about cost savings.”
But the transparency issue isn’t just a patient problem — pharmacies may suffer, too.
According to Bromstedt and Morris, arbitrary fees are often added, without clear explanation of what the fees are for and why they are charged. These include direct and indirect numeration fees, which are charged to retail pharmacies.
Morris gave an example where he gives a patient a prescription that costs $30 — $20 in copay for the insurance company and $10 for the pharmacy. Later, the pharmacy may receive a statement with the additional fees.
“They don’t tell us where they are taking money from, Morris said. “They don’t tell us the prescription number, the name of the person.”
He said sometimes pharmacies get thousands of dollars taken in the name of the fees after the prescription is filled.
This has caused some pharmacies to shut their doors, Bromstedt said. It’s made her pay attention to her business’ profitability.
Morris said pharmacies can be charged for Medicare patient noncompliance. But there is only so much a pharmacy can do to ensure patient compliance.
“What power do I have over that patient if he wants to be noncompliant?” Morris asked. “I have no power.”
Bromstedt said this has forced Kilgore’s to create a program to check up on patients, deliver medications and keep track of prescription compliance. She said this costs the pharmacies more money because it increases the workload and costs for the pharmacy.
Bromstedt said she hopes the bill passes but that there’s a lot more to be done in creating awareness about this issue. She said the current system makes it difficult for pharmacists to do what they’ve been trained to do.
“I’m super passionate about this because there’s a lot of stuff that’s going on behind the scenes in pharmacy that people don’t know about,” Bromstedt said. “It’s directly affecting small, independent pharmacies.”
Both Bromstedt and Morris said they urged customers to ask questions about cheaper alternatives. Bromstedt said it’s essential for customers to know their rights and to understand their co-pay structures.
Similar bills have been passed in six state legislatures and are pending in 25, according to the National Conference of State Legislatures.
Supervising editors are Jeanne Abbott and Tynan Stewart.