Senate Passes Bill Prohibiting Pharmacy “Gag Clauses” for Employer Health Plans

September 21, 2018

The Senate passed the Patient Right to Know Drug Prices Act (S. 2554), which would prohibit an insurer or pharmacy benefit manager from restricting a pharmacy’s ability to tell consumers when their insurance copay is higher than the cash price for a drug.

The bill would apply to employer health plans as well as individual plans sold on and off the ACA exchanges.  The House is working on similar legislation (H.R. 6733), which has passed the Energy and Commerce Committee, but has not yet been scheduled for a floor vote.

A recent JAMA study found 23 percent of prescriptions cost more to patients if they were filed through their insurance instead of paid out-of-pocket.
 
Twenty-six states enacted laws prohibiting the gag clauses between 2016 and Aug. 21, 2018, according to the National Conference of State Legislatures. 

Outlook:  The Senate and House bills have broad bipartisan support and President Trump has signaled he would sign the legislation if it reaches his desk.  However, there are not many days left on the Congressional calendar this year.