- “The clauses force the pharmacists to remain silent as, for example, a consumer pays $125 under her insurance plan for an influenza drug that would have cost $100 if purchased with cash.”
“Much of the difference often goes to the drug benefit managers.”
- Gag laws in most states
- “At least five states have adopted laws to make sure pharmacists can inform patients about less costly ways to obtain their medicines, and at least a dozen others are considering legislation to prohibit gag clauses… “
- “A consumer filling a prescription for a drug to treat diabetes or high blood pressure may owe $20 if he uses insurance coverage. By contrast, a consumer paying cash might have to pay $8 to $15.”
- North Dakota and a good law for consumers, but it being sued by Pharmaceutical Care Management Association,
- “In North Dakota, a new law explicitly bans gag orders. It says that a pharmacy or pharmacist may provide information that “may include the cost and clinical efficacy of a more affordable alternative drug if one is available.”
- “The North Dakota law also says that a pharmacy benefit manager or insurer may not charge a co-payment that exceeds the actual cost of a medication.”
- Pharmacy ‘Clawbacks’ Targeted in Latest State Law Aimed at PBMs July 2017, law passed in Connecticut
"Most patients never realize there’s a cheaper cash price because of clauses in contracts between pharmacies and PBMs that bar the drugstore from telling people there’s a cheaper way to pay."
- What Do Clawback Fees Mean for Pharmacies and Patients? iMedicare.com
- Search Google for clawbacks pharmacy 36,000 hits Feb 2018
A few years ago I picked up 4 prescriptions for my father-in law.
One "prescription" was for a bottle of 12 aspirin,which cost $12 (325 mg = standard dose)
On the shelf at the drugstore was a bottle of aspirin costing $0.01 per pill
I suspect the pharmacist got about $4 for selling the "prescription"
I also suspect that the doctor was able to bill Medicare for making the prescription.