You’re probably paying too much for your prescription medicine, and your pharmacist can’t tell you. Why?
A “gag clause” forbids them.
“It’s frustrating, I can’t discuss it for obvious reasons,” said Steven Nelson, an independent pharmacist with Okeechobee Discount Drugs. “Unfortunately our hands are tied, and we would like to help the public, but we have to be very, very careful of what we say.”
Why does he have to be careful? Sometimes, your co-pay is more expensive than the cost of the drug. Pharmacists call it a “clawback” and here’s how it works: Some of your co-pay is actually “clawed back” by middlemen known as Pharmacy Benefit Managers or PBM’s, who negotiate the price you pay for medication on behalf of your insurance company.
“To know there’s these secret middlemen that are taking their side of the profit, I don’t really want to know that’s happening without my knowledge,” said Fort Myers parent, Dave Fortenbaugh.
Because of these clawbacks, you may be paying more for your medication without even knowing it. “I don’t think anyone likes to find out that there is something going on that is not open and transparent,” said Fortenbaugh.
While most people believe that using insurance reduces prices, sometimes medication is cheaper when you don’t use insurance. However, pharmacists can’t tell you that because of the gag clause in their contracts with none other than the PBM’s.
“We would like to save the patient money, but the information would have to come from the patient first,” said Nelson.
Several states have outlawed clawbacks and gag clauses, but Florida isn’t one of them. Still, there is one way to protect yourself, and your wallet, by asking one simple question: “Can I get this cheaper without insurance?” That question unlocks the gag clause.
Mary McGuire recently learned about these clawbacks, as well as the gag clause.
“That’s disheartening for sure,” said McGuire.
McGuire called her pharmacy, and then went online to www.GoodRx.com where she compared her medications and found lower prices.
Meanwhile, the Pharmaceutical Care Management Association that represents PBM’s said in a statement: “Pharmacy benefit managers (PBMs) typically reduce prescription drug costs by 30 percent for more than 266 million Americans enrolled in private and public plans, most notably Medicare Part D. In fact, PBMs will save patients and payers $43.4 billion in Florida over 10 years. We support the patient paying the lowest price available at the pharmacy counter for the prescribed drug.” -Greg Lopes, PCMA, Senior Director, Strategic Communication
The Pharmaceutical Care Management Association would not comment on the gag clause. So, the bottom line is that it pays to ask. Don’t assume that going through your insurance will get you the best price on prescriptions drugs.
Ask the pharmacist: “Can I get this cheaper without insurance?” Do your research. Check out websites like GoodRx.com and LowestMed.com before you blindly open your wallet, and pay for prescription medication.