A bill that would ban pharmacy benefit managers from imposing so-called “gag clauses” on pharmacists to keep them from telling customers about cheaper generic drugs is headed to Gov. Tom Wolf’s desk to be signed into law.
“People have a right to affordable health care and to get the best price possible for their prescription drugs,” state Rep. Valerie Gaydos, R-44, Aleppo Township, said in a statement after her House Bill 943 unanimously passed the House on Tuesday.
“Oftentimes, there are several inexpensive, generic medicines for which an insurance co-pay can often be more expensive than if the patient simply pays out-of-pocket, bypassing their insurance company altogether,” said Gaydos. “I have personally heard from many pharmacists in my district who want to help their customers find low-cost alternatives, but they are unfortunately forbidden from doing so.”
The bill, introduced by Gaydos in April 2019, initially passed the House unanimously in November. It was amended and unanimously passed by the Senate and then the House approved the amended version this week.
Pennsylvania Auditor General Eugene DePasquale, the Democratic candidate for the 10th Congressional District in south-central Pennsylvania, has been a proponent of reforming the pharmacy benefit managers (PBMs) in the state, including prohibiting gag clauses, and released reports on PBMs in 2018 and 2019.
Among their responsibilities, PBMs set drug reimbursement rates for pharmacies and determine which medicines are covered by insurance. DePasquale has said that Pennsylvania paid PBMs $2.86 million in 2017 for services to Medicaid enrollees, a 100% increase from 2013.
Independent pharmacies have long complained that the constraints placed on them by PBMs are driving them out of businesses or forcing them to sell to corporate pharmacy chains.
“As I’ve warned for years, gag clauses ultimately prevent pharmacists from giving customers practical advice on how to save money on their prescriptions,” DePasquale said in a statement. “In some cases, consumers might save money by paying cash instead of using their insurance, but gag clauses stop pharmacists from volunteering that helpful advice unless a customer specifically asks.”
State Rep. Rob Matzie, D-16, Ambridge, the House Democratic chairman of the Community Pharmacy Caucus, has also called for reforms to PBMs and introduced legislation, mired in the Senate, that would increase transparency in PBM pricing practices for Medicaid prescription drugs.
“I am pleased a bill from a package of legislation is getting across the finish line,” Matzie said on Wednesday. “This pro-consumer bill will allow pharmacists the opportunity to discuss lower priced alternatives removing the so-called ‘gag clause’ that limits a medical provider from disclosing costs to a patient. Any provision that prevents full disclosure has no place in law.”