For years I’ve been paying cash for certain prescription drugs, even when I have health insurance. This simple trick has saved me 50 percent or more — but you’re unlikely to hear about it at your pharmacy.
Pharmacists are often barred from telling customers that a drug would be cheaper if they paid out of pocket — also referred to as paying cash — instead of going through their health insurance.
At issue are gag clauses in contracts between pharmacies and drug benefit managers, as The New York Times detailed recently:
“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.”
Drug benefit managers, as their name suggests, are companies that manage drug benefits on behalf of health insurance companies and employers. That entails negotiating prices with pharmacies and drug manufacturers, making benefit managers powerful middlemen of sorts.
In a Senate Health Committee hearing in December, Norman Augustine, chairman of the nonprofit National Academies of Sciences, Engineering and Medicine’s Committee on Ensuring Patient Access to Affordable Drug Therapies, testified that a lack of transparency is at issue:
“The fact is that people don’t know what is in the agreements that are made between, for example, the drug companies and those in the supply chain, so most people will never even know that a gag clause is there today.”
Fighting high drug prices
The New York Times notes that some states have passed or are working on legislation to block gag clauses, and some federal lawmakers are looking into addressing gag clauses. So, you might want to contact your senators and House representatives to voice your opinion on the matter.
In the meantime, though, you can get around gag clauses on your own. If you buy any prescriptions through your insurance — likely meaning you pay a predetermined copay for them — pick up the phone and ask your pharmacy for its cash prices for those drugs.
Better yet, call around to a few pharmacies. Cash prices can vary widely between traditional pharmacy chains and pharmacies located in big-box and warehouse stores, for example.
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