Pharmacists can help customers save money under new Stabenow bill

WASHINGTON — Pharmacists will be able to talk up front to Medicare customers about the cheapest way to afford prescription medication under legislation sponsored by U.S. Sen. Debbie Stabenow, D-Mich., which was passed this week and is now being considered in the U.S. House of Representatives.

On a unanimous vote Tuesday, the Senate agreed to Stabenow’s bill, which prohibits pharmaceutical benefit managers from writing rules into contracts with pharmacists that keep them from telling patients that some medications may cost less if paid for in cash than the co-pay required under their insurance.

Stabenow, along with U.S. Sen. Susan Collins, R-Maine, is also expected to see action as soon as next week on legislation that would ban the practice of writing so-called gag orders into pharmacists’ contracts for patients with employer-sponsored, private or insurance sold on state exchanges under the Affordable Care Act. And U.S. Rep. Buddy Carter, R-Ga., who is himself a pharmacist, also won subcommittee approval for a companion bill in the House Energy and Commerce Committee on Friday.

“This is a really important step forward,” said Stabenow, who explained that the bills had to be split up in the Senate because different committees handle different kinds of insurers. "It bans these gag clauses so that pharmacists have the freedom (to tell customers) the best way to get the lowest price at the counter. It seems pretty basic to me.”

Stabenow had more then a half-dozen co-sponsors for her legislation, including Democrats and Republicans.

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Joining Stabenow on a conference call with reporters on Friday afternoon was Larry Wagenknecht, the chief executive officer of the Michigan Pharmacists Association, who explained that in many cases, pharmacists are prohibited by their agreements with benefit managers to initiate conversations on the cheapest way of paying for medications – though, in Michigan at least, as well as in some other states, they can provide that information if asked by the patient.

Under the new legislation, however – which they lobbied for – pharmacists would be able to tell customers up front if their co-pays are higher than the price they would pay for medication if they simply paid out of pocket. 

It’s apparently no small matter nationally, either. A report done earlier this year at the University of Southern California, which compared national drug reimbursements with claims data from a large commercial insurer, indicated that 23 percent of the filled pharmacy prescriptions involved a patient co-payment that exceeded the reimbursement for the drug by the insurer by more than $2. Among those overpayment claims, the average overpayment was $7.69.

Stabenow said her legislation and the other bills – if finally passed by Congress and signed into law by President Donald Trump – would help situations such as those in which a customer is paying a $20 co-pay for high blood pressure or diabetes medicine that would only cost them $8 out of pocket, but wouldn’t know that unless he or she asked, since the pharmacist couldn’t say.

The Michigan Legislature is also considering bills to address the situation.

“The contracts the pharmacists are forced to sign, they’re a take it or leave it situation,” said Wagenknecht, who added that in recent years there has been an “explosion” in higher co-payment structures for patients. “It’s a big deal in Michigan."

Stabenow said that the only response she has heard from benefit managers is that such gag rules are used infrequently if ever. Considering the bipartisan nature of the legislation  – with votes in the House subcommittee and on the Senate floor being unanimous – it appears there is little in terms of obstacles toward passage of the measures. 

Charles Cote, a spokesman for the Pharmaceutical Care Management Association, which represents pharmaceutical benefits managers, said the organization "would oppose contracting that prohibits drugstores from sharing with patients the cash price they charge for each drug. These rates are set entirely at the discretion of each pharmacy and can vary significantly from drugstore to drugstore. Fortunately, to the degree this issue was ever rooted in more than anecdotal information, it has been addressed in the marketplace.”

“We support the patient always paying the lowest cost at the pharmacy counter, whether it’s the cash price or the copay," he said. "This is standard industry practice in both Medicare and the commercial sector."

Contact Todd Spangler at tspangler@tspangler@freepress.com. Follow him on Twitter at @tsspangler.