Pharmacists May Soon Be Allowed to Proactively Provide People with Medicare Information about Cheaper Medications

This week, Congress passed two bipartisan bills aimed at removing barriers that may prevent people from paying the lowest possible price for their prescription drugs. The legislation will prohibit contractual limitations that can stop pharmacists from volunteering information about how consumers may be able to save money on their needed medications.

The Patient Right to Know Drug Prices Act (S.2554) bars insurers and Pharmacy Benefit Managers (PBMs) from restricting a pharmacy’s ability to tell consumers when there is a difference between how much they would pay for a drug using their insurance and how much they would pay without it. This bill applies to plans offered through the Affordable Care Act’s exchanges and by private employers. The Know the Lowest Price Act (S. 2553) provides this same protection for individuals who are covered by Medicare Advantage and Medicare Part D plans.

It is unclear how many Medicare Advantage or Part D plans include this practice currently. Where they exist, they allow pharmacists to respond to direct questions about drug price comparisons, but not to pre-empt such questions by proactively telling people with Medicare that they might benefit from not using their Medicare prescription drug coverage. This legislation, which the president is expected to sign soon, will prevent PBMs and insurers from requiring pharmacists to stay silent unless asked. We applaud these improvements, and thank Senators Collins (R-Maine), McCaskill (D-Missouri) and Stabenow (D-Michigan) for their leadership on this bipartisan effort.

Though consumers can already ask pharmacists about their cost options, many do not know they need to ask for this information, or that doing so could save them money. Medicare Rights does not support the intentional or inadvertent withholding of drug pricing information from consumers in general, especially when it could empower them to improve the affordability of their health care and prescription drugs in particular. To the contrary, we believe that pharmacists and prescribers should be encouraged to give information freely to people with Medicare that may help them better manage costs. In addition, we urge practitioners to look into alternatives when drug prices or other health costs are unusually high, or when patients express or exhibit concerns about affordability.

Earlier this year in our response to the Administration’s Drug Pricing Blueprint, we agreed that pharmacies should be allowed to proactively provide information about cheaper medications. We appreciate congressional action on this issue, and encourage policymakers to continue to pursue reforms that help people with Medicare better afford their prescriptions.

Read more about this issue.

Read our comments on the Administration’s Drug Pricing Blueprint.

Read this bill.