Troubleshooters: Pharmacist Gag Rule

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Troubleshooters: Pharmacist Gag Rule. Nydia Han reports during Action News at 12:30 p.m. on May 20, 2018. (WPVI)

Action News Troubleshooter Nydia Han is exposing a disturbing practice in the pharmaceutical world.

It's a rule that gags your pharmacist from providing you money-saving options.

It's a hard pill to swallow, the reality that your pharmacist is forbidden from helping you save money on your medication.

When you pay for a prescription, you might be like Michael Dugan.

"Always use my insurance," he said.

But these three words, Pharmacist Gag Rule, might have you paying cash instead.

"I have never heard of this gag rule," Dugan said.

Most consumers haven't, so here's what you need to know: The Gag Rule is a clause written into contracts between pharmacists and PBMs, pharmacy benefit managers.

"These people are outsourced by the insurance companies to handle their prescription programs," said Mel Brodsky.

The rule forbids pharmacists from telling customers they could save money by paying out-of-pocket instead of using their insurance.

"This is really frustrating," Dugan said.

Brodsky leads an association for local pharmacists.

"It's not fair to anybody," he said.

Brodsky says PBMs enacted the Gag Rule out of greed because they pocket the difference between the insurance copay and the cash price.

He also says PBMs drive up the cost of medication overall.

"Their CEOs make between 15 and 20 million dollars a year. There's a lot of money that the middlemen are taking," said Brodsky.

The PBM association claims it supports patients paying the lowest price, and opposes the Gag Rule.

But many states are making pharmacist gag rules illegal. In two years, at least 21 states have passed laws prohibiting them.

"It's a really disturbing practice," said Senator Sharif Street. He has co-sponsored legislation to ban pharmacist gag rules in Pennsylvania.

President Trump says his new federal plan would do the same.

Meantime, there are a couple simple things you can do to get around this practice.

"They can go online they can check a drug price and see what it's going to be at a pharmacy in their location, said Shawn Ohri of WellRx.

You can search on free websites like WellRX and GoodRX. They provide consumers cards or coupons for the prices they show, which include special discounts.

"Using a tool like WellRX, you can come in with a price and information and hand it to the pharmacist, added Ohri.

And here's a really simple thing you can do: Just ask. Ask your pharmacist what the cash price is. The pharmacist can't volunteer the information but if you ask, the pharmacist is allowed to answer.

This is part of our continuing effort to create transparency in health care and save you money through Philly Health Costs, our partnership with the Philadelphia Inquirer.

PARD - an Association of Community Pharmacists

Pharmaceutical Care Management Association

PA Senate Bill 637

Prescription Drug Resource Center - Gag Rule

President Trump's plan for drug prices

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