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Carter Introduces Measure to Prohibit "Gag Clause" Provisions

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Washington, September 7, 2018 | comments
Congressman Earl L. "Buddy" Carter (R-Ga.) introduced legislation today to prohibit "gag clause" provisions.

Currently, Pharmacy Benefit Managers (PBMs) are able to include requirements in contracts that prevent pharmacists from providing advice to their patients on the best and cheapest out-of-pocket alternatives to medications covered under insurance. This is commonly known as a "gag clause." As a result, patients may be paying more for their prescriptions than is warranted.

The Know the Cost Act introduced by Carter today prohibits group health plans offered by employers and individual health insurance plans, as well as Medicare Advantage and Medicare Part D Plans, from restricting a pharmacy’s ability to inform a patient about the lower cost, out-of-pocket price options for their prescription. Additionally, the measure will require notifications to Medicare beneficiaries of the potential outcomes of paying out-of-pocket rather than with insurance. 

The measure was approved today by the House Energy and Commerce Committee's Health Subcommittee and similar legislation is moving through the United States Senate at this time. 

"As a pharmacist for more than 30 years, I can say firsthand that I was prohibited many times from telling my patients that there was a cheaper option available to them because of a gag clause," Carter said. "Pharmacists must be able to tell patients what is in their best interest and this legislation works to make that happen. Patients need and deserve the most affordable options. 

"The Know the Cost Act builds on legislation I introduced earlier this year. The strong, bipartisan support of this measure shows the importance of moving this bill across the finish line as part of our mission to lower prescription drug prices for Americans. I am very glad it was approved by our Health Subcommittee today and I look forward to it moving through committee and reaching the House floor."

The legislation now moves to consideration by the full House Energy and Commerce Committee.
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