Antitrust Lawyer Blog
On a day, that President Trump’s Department of Justice approved CVS’ acquisition of Aetna, allowing the vertical integration of a pharmacy benefit manager with a health insurer, he signed two bills into law intended to lower patients’ prescription costs: the Know Your Lowest Prices Act and the Patient Right (S. 2553) to Know Drug Prices Act (S. 2554). The bills prohibit health insurers and pharmacy benefit managers (“PBMs”) from including so-called “gag clauses” in contracts with pharmacies. The clauses ban pharmacists from notifying patients when they could pay less for medicines without using their health insurance than they would for their copayment.
The Laws Should Reduce Patient Out-of-Pocket Spending by Eliminating Gag Clauses and Increase Drug Pricing Transparency
It is important to eliminate pharmacy gag clauses that prevent pharmacists from informing consumers of lower priced alternatives. In a competitive market, we would expect providers would have the ability to guide consumers to the best products at the lowest cost. The fact that PBMs had a practice of preventing pharmacies from disclosing this information means competition was not working as it should.