In the effort to improve transparency for patients at the pharmacy counter, Congressman Scott Taylor (VA-2) has thrown his support behind the Transparency Health Care Pricing Act of 2018, which would require that “entities that offer or furnish” healthcare-related products or services to disclose to the public the price of those products and services at the point of purchase, whether in-store or online. The legislation will help patients in reducing out-of-pocket costs, as well as doing away with so-called “gag clauses” that prevent pharmacists from informing patients that a certain drug or medication would be cheaper without using a patient’s insurance to pay for it.
Pharmacists and pharmacy benefits managers (PMBs) can get into trouble with insurance companies if they “violate” a contract by discussing the cost of a drug or medication without a patient’s insurance plan.
In 2015, pharmacy in-store, mail order, and online consumer purchases of prescription drugs were a $235 billion market in the U.S., with at least 4.45 billion prescriptions written, according to the Prescription Drug Resource Center. The rollback of gag clauses as become a big issue among state legislature within the past few years, with Virginia enacting law to allow better transparency for patients this year.
Currently, eight states, along with Washington, D.C., still do not have any legislation prohibiting gag clauses between pharmacists, PMBs, and insurance companies. Therefore, the federal government has decided to step in to ensure that those paying for prescriptions have the option to pay out-of-pocket, leading to better prices.
“Each year, Americans are forced to navigate a complex and costly healthcare system that leaves them with more questions than answers,” Taylor said via a press release. “By making healthcare prices publicly available, we can empower consumers and spur competition which will ultimately bring down healthcare costs for everyone and increase accountability,” the congressman added.
Within the bill, healthcare providing operators must specifically disclose all prices, “including wholesale, retail, and discounted prices, that are accepted as payment in full for products and services provided to individual consumers.” Furthermore, the bill also directs the Department of Health and Human Services (HHS) to investigate and impose civil penalties on entities that fail to comply such requirements.
Taylor explained that he will “also be working on legislation to expand consumer access to healthcare costs so that they [patients] can make the best decision for themselves and their families.”