U.S. Reps. Cathy McMorris Rodgers (R-WA), Erik Paulsen (R-MN), and Michael Burgess (R-TX) on Sept. 7 unveiled the bipartisan Know the Cost Act of 2018, which aims to prohibit gag clauses regarding prescription drug prices.
H.R. 6733, lead sponsored by Earl “Buddy” Carter (R-GA), who was a pharmacist for more than 30 years, would prohibit group health plans, health insurance issuers, prescription drug plan sponsors, and Medicare Advantage organizations from limiting certain information on drug prices by gag clauses included in the fine print of contracts.
Such clauses, which are imposed by pharmacy benefit managers (PBMs), prevent pharmacists from informing patients that a drug could cost less out-of-pocket than paid for by insurance, unless the patient directly requests such information, according to the lawmakers, who added that H.R. 6733 would improve transparency for Americans at the pharmacy.
“There is no reason pharmacists should not be able to talk to patients about what is best for them,” Rep. Carter said earlier this year. “Many times, my patients were senior citizens who had to choose between groceries and their prescription. These patients need and deserve the most affordable options.”
Rep. McMorris Rodgers said the bill will help lower the costs of prescription drugs, which she said continue to skyrocket. “One way we can work to increase patient choice is by making sure they have the information to make the best decisions for themselves and their families,” the congresswoman said in a Sept. 7 statement.
“If our pharmacists, health insurance issuers, and PBMs have access to the cost of our prescriptions, so should our patients,” McMorris Rodgers added.
PBMs are the middlemen that employers and federal programs use to set prescription drug prices for consumers on their health plans, according to Rep. McMorris Rodgers’ statement, and PBMs many times don’t explain the process for setting these prices.
“While they claim to deliver cost savings by passing along rebates to federal programs, the lack of transparency surrounding PBMs makes it impossible to track these alleged savings,” according to the statement.
Several Democrats joined Reps. McMorris Rodgers, Burgess and Paulsen as original cosponsors of H.R. 6733, including U.S. Reps. Lloyd Doggett (D-TX) and Peter Welch (D-VT), among others.
H.R. 6733 has been referred to the U.S. House Energy and Commerce Committee and the House Ways and Means Committee for consideration.