"In my opinion, it needs to stop.”
That’s what a Minnesota pharmacist told KARE 11 three years ago as he helped expose how people were being overcharged on some prescription medicines – even when they used insurance.
Now, a Minnesota lawmaker wants to ban so-called "gag clauses," which have prevented pharmacists from telling customers how they may be able to save money by paying cash rather than using insurance.
“We have pharmacists that would love to tell their patients, 'If we do this, we can save you 75 percent,’” state Senator Scott Jensen (R-Chaska) told KARE 11.
Too often, they can’t.
Prescription price secrets
"By me giving this information out, you know, I’m risking losing my contracts,” explained a Minnesota pharmacist who asked KARE 11 not to use his name.
In 2016, he helped KARE 11 obtain internal pharmacy records showing how it was less expensive to pay cash for some prescription medicines rather than using insurance.
For example, records at the time showed the anti-depressant Venlafaxine cost $67.13 with insurance, but only $24.99 if you paid cash.
However, KARE 11 reported that because of "gag clauses" many pharmacists haven’t been able to tell customers about potential savings like that.
Pharmacies have been required to sign the gag clauses as part of their contracts with Pharmacy Benefit Managers. PBMs act as middle-men between insurance providers and pharmacies. Experts say PBMs often set the prescription prices you pay.
Calling for transparency
Senator Jensen has introduced legislation to outlaw contract requirements like that.
“We need to blow open the doors of transparency across the health care industry, but certainly in the world of pharmacy,” he said.
President Trump recently signed a federal law banning some gag clauses, but experts say it doesn’t cover all of them.
“I think our bill is substantially more expansive than what the feds are trying to do,” Jensen told KARE 11.
He also wants to license pharmacy benefit managers, saying drug manufacturers aren’t the only ones driving up the prices of medications. He thinks PBMs are also to blame.
Jensen, who is also a family physician, believes licensing PBMs would be a step toward protecting patients like the ones he sees from soaring bills.
“They’ve come and told me the horror stories,” he said. “And they say, ‘Can you help us?’”
Insurance companies and PBMs say they are committed to holding down prescription costs. With licensing and greater disclosure Jensen hopes to make sure they do.
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