Why Your Pharmacist Can’t Tell You That $20 Prescription Could Cost Only $8
為什麼你的藥師不能告訴你20美元的處方可能只花費你8美元
Extracted from:The New York Times
https://www.nytimes.com
By ROBERT PEAR FEB. 24, 2018
States are moving to block “gag clauses” that prohibit pharmacists from telling customers that they could save money by paying cash for prescription drugs rather than using their health insurance.
As consumers face rapidly rising drug costs, states across the country are moving to block “gag clauses” that prohibit pharmacists from telling customers that they could save money by paying cash for prescription drugs rather than using their health insurance.
Many pharmacists have expressed frustration about such provisions in their contracts with the powerful companies that manage drug benefits for insurers and employers. 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.
Federal and state officials say they share the pharmacists’ concerns, and they have started taking action. 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, according to the National Conference of State Legislatures.
Senator Susan Collins, Republican of Maine, said that after meeting recently with a group of pharmacists in her state, she was “outraged” to learn about the gag orders.
“I can’t tell you how frustrated these pharmacists were that they were unable to give that information to their customers, who they knew were struggling to pay a high co-pay,” Ms. Collins said.
Alex M. Azar II, the new secretary of health and human services, who was a top executive at the drugmaker Eli Lilly for nearly 10 years, echoed that concern. “That shouldn’t be happening,” he said.
Pharmacy benefit managers say they hold down costs for consumers by negotiating prices with drug manufacturers and retail drugstores, but their practices have come under intense scrutiny.
The White House Council of Economic Advisers said in a report this month that large pharmacy benefit managers “exercise undue market power” and generate “outsized profits for themselves.”
Steven F. Moore, whose family owns Condo Pharmacy in Plattsburgh, N.Y., said the restrictions on pharmacists’ ability to discuss prices with patients were “incredibly frustrating.”
Mr. Moore offered this example of how the pricing works: 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.
Mark Merritt, the president and chief executive of the Pharmaceutical Care Management Association, which represents benefit managers, said he agreed that consumers should pay the lower amount.
As for the use of gag clauses, he said: “It’s not condoned by the industry. We don’t defend it. It has occurred on rare occasions, but it’s an outlier practice that we oppose.”
However, Thomas E. Menighan, the chief executive of the American Pharmacists Association, said that such clauses were “not an outlier,” but instead a relatively common practice. Under many contracts, he said, “the pharmacist cannot volunteer the fact that a medicine is less expensive if you pay the cash price and we don’t run it through your health plan.”
A bipartisan measure that took effect in Connecticut this year prohibits the gag clauses. It was introduced by the top Democrat in the Connecticut Senate, Martin M. Looney, and the top Republican, Len Fasano.
“This is information that consumers should have,” Mr. Looney said in an interview, “but that they were denied under the somewhat arbitrary and capricious contracts that pharmacists were required to abide by.”
Mr. Fasano said that consumers were sometimes paying three or four times as much when they used their insurance as they would have paid without it. “That’s price gouging,” he said in an interview.
The legislation, Mr. Fasano said, encountered “a lot of resistance” from large pharmacy benefit managers and some insurance companies.
In North Carolina, a new law says that pharmacists “shall have the right” to provide insured customers with information about their insurance co-payments and less costly alternatives.
A new Georgia law says that a pharmacist may not be penalized for disclosing such information to a customer. Maine has adopted a similar law.
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.
The lobby for drug benefit companies, the Pharmaceutical Care Management Association, has filed suit in federal court to block the North Dakota law, saying it imposes “onerous new restrictions on pharmacy benefit managers.”
Specifically, it says, the North Dakota law could require the disclosure of “proprietary trade secrets,” including information about how drug prices are set. “P.B.M.–pharmacy contracts typically preclude a pharmacy from disclosing to the patient the amount of a reimbursement,” the lawsuit says.
Gov. Asa Hutchinson of Arkansas, a Republican, said this past week that he would call a special session of the State Legislature to authorize the regulation of pharmacy benefit managers by the state’s Insurance Department.
He said he feared that some independent pharmacists receiving “inadequate reimbursement” from the benefit managers might go out of business, reducing patients’ access to care, especially in rural areas.
美國各州正在採取行動來阻止｢封口條款｣，此條款意在不允許藥師向消費者告知他們可以透過現金支付處方藥來省錢，而不是使用他們的健康醫療保險。
隨著消費者面臨的藥品成本迅速上升，美國各州都在努力阻止｢封口條款｣，此條款意在不允許藥師告知消費者可以通過現金支付處方藥來省錢，而不是使用他們的健康醫療保險。
當接觸到與保險公司和雇主間有往來的藥品給付管理公司時，許多藥師對這些條款表示失望。這些條款迫使藥師保持沉默，例如消費者根據保險計畫支付125美元的流感藥物，如果用現金購買的話，該藥的花費只需100美元。
大部分的價差往往是由藥品給付管理公司所賺取。
聯邦和州政府官員表示他們對藥師的擔憂感同身受，他們已經開始採取行動。根據州議會全國會議的說法，至少有五個州通過了法律，以確保藥師能夠告知病人花費較少而獲得藥品的方法，而且還有至少有十多州正在考慮立法阻止這些禁止條款。
緬因州共和黨參議員Susan Collins在最近和她所在州的藥師們會面後表示，她對於那些封口條款感到 ｢憤慨｣。
參議員Collins女士表示：｢我實在很難描述當這些藥師們無法向那些想盡辦法給付高額自付額的客戶們提供資訊時，他們是有多麼的沮喪。｣
新任的衛生和公共服務部長，Alex M. Azar II，曾在Eli Lilly製藥公司擔任將近十年的高層行政人員，對此回應說：｢那些情形不應該發生。｣
藥品給付管理公司說他們透過與藥品製造商和零售藥店的議價，來降低消費者的花費, 但他們的做法受到了嚴格的審查。
白宮經濟顧問委員會在本月的一份報告中表示，大型的藥品給付管理公司｢行使不正當的市場權力｣，並產出｢超額利潤｣
在紐約州的Plattsburgh經營Condo藥局的Steven F. Moore表示，限制藥師與病人的議價空間是｢相當令人的沮喪｣的一件事。
Moore提供了一個關於藥價的例子：如果消費者使用保險支付治療糖尿病或高血壓的藥物處方可能要20美元。相比之下，消費者用現金支付可能只需要8美元到15美元。
代表藥品給付管理公司的美國藥物照顧管理協會總裁兼首席執行長Mark Merritt表示，他同意消費者應支付較低的金額。
至於封口條款，他說：｢這是不被業界所寬恕的。我們不會去捍衛它。它發生在極少數的場合，而且是我們反對的異常做法。｣
然而, 美國藥師協會首席執行長Thomas E. Menighan說，這類條款｢不是一個異常做法｣，而是一種相對很普遍的做法。他表示在許多契約下，藥師不能自願表達一個事實，就是如果你支付現金且沒有透過你的健康計畫的藥物花費是比較便宜的。
在康涅狄格州，由兩黨共同的制定的政策阻止了那些封口條款。這是由在康涅狄格州參議院民主黨高層代表Martin M. Looney和共和黨高層代表Len Fasano所引導出來的。
｢這是消費者應該擁有的資訊｣，Looney先生在接受採訪時說，｢但他們被拒於門外，而原因竟來自一些藥師必須遵守的蠻橫和任性的契約。｣
Fasano先生說，消費者有時透過保險會多支付三或四倍的花費，比起沒有使用保險支付。｢這是價格欺詐｣他在接受採訪時說道。
Fasano先生說，這項立法遇到了很多來自大型的藥品給付管理公司和一些保險公司的阻力。
在北卡羅萊納州，一項新的法律規定藥師｢有權｣向投保的客戶提供和其保險自付額或是其他成本較低的替代方案的相關資訊。
一條新的喬治亞州的法律規定，藥師不得因向顧客透露此類資訊而受到懲罰。緬因州也通過了類似的法律。
在北達科他州，一項新的法律明確阻止了禁止條款，並規定藥房或藥師提供的資訊，可包括藥物花費和具有同樣臨床功效且更實惠的替代藥物。北達科他州的法律還說，藥品給付管理公司或保險公司不得收取超過實際藥品費用的自付額。
替藥品給付管理公司遊說的藥物照顧管理協會在聯邦法院提起訴訟，意圖阻止北達科他州的立法，稱其對藥品給付管理公司施加了｢繁重的新限制｣
具體地說，北達科他州的立法可能要求披露｢專賣商業秘密｣，包括有關藥品價格如何設立的資訊。該法宣稱｢P.B.M.–pharmacy契約｣通常阻止藥房向病人透露差額。
共和黨籍阿肯色州州長Asa Hutchinson上周表示，他將召開一次州議會特別會議，授權州保險部門對藥品給付管理公司進行監管。
他說他擔心一些獨立藥師從藥品給付管理公司那裡得到｢不足額的補償｣，導致這些藥局可能會破產而倒閉，特別是在農村地區，進而使病人減少獲得醫療的機會。