Consumers have the right to be aware of all their prescription options and associated costs. Some contracts between health insurers and pharmacies prevent pharmacists from informing their patients of an identical prescription they can purchase at lower prices outside their benefit or insurance plan. As an independent pharmacist, I understand how this practice affects consumers. That’s why as a member of the Committee on Public Health, I worked on a new law prohibiting these “gag clauses.” Now, all pharmacists are able to help Hoosier consumers save on their prescription drug costs.
Currently, customers could be overpaying for their prescriptions when using their insurance coverage’s prescription copayment. Copayments take place when the customer and insurer share the total cost of the drug, and the customer pays the copayment and the insurer pays the remaining amount. In some instances, consumers are paying more through the copay than the cost of the medication itself or a generic version. Insurers then claim the remaining difference in what is known as a “clawback.”
For example, an insured patient could be prescribed a drug to aid migraine headaches. All charges and total fees for that drug could only be $12, but their insurance company charges them a minimum $50 copay. The remaining $38 the patient paid will be returned to the insurance company’s pharmacy benefits system through the “clawback.”
This new law will implement an “anti-gag clause” for insurance company contracts with pharmacies. It ensures pharmacists have the freedom to disclose and recommend better medication purchasing options to their customers without contractual repercussions. This is a necessary step to guarantee patients have access to the most affordable prescriptions and are fully informed during the decision-making process.
Price transparency is essential to controlling runaway healthcare costs, and I plan to continue working on these issues while serving as your state representative. If you have any questions or concerns about this new law, please contact me at firstname.lastname@example.org or 317-232-9769.
Rep. Steve Davisson represents Washington County, and portions
of Orange, Lawrence, Jackson, Clark and Harrison counties.
A high-resolution photo of Davisson can be downloaded by clicking here.