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7700 E. 1st Place, Denver, CO 80230 direct (303) 856-1367 Prohibiting PBM Gag Clauses that Restrict Pharmacists from Disclosing Price Options: Recent State Legislation 2016-2018 July 23, 2018 Compiled by the ncsl Health Program, Richard Cauchi, Program Director Pharmacy-based and mail-order consumer purchases of prescription drugs were a $235 billion market annually in the United States in 2015. Commercial contracts between a pharmacy and a Pharmaceutical Benefit Manager (PBM) are a widespread feature in the distribution and sales chain between original manufacturer and the end consumer. However, the terms of these arrangements and binding contracts usually are invisible to individual consumers and some purchasers such as employers. In some cases, these arrangements include restrictions that mean a pharmacist is prohibited by a contract with a PBM from informing consumers that the drug they want to buy has purchase options, and could be purchased at a lower cost if the consumers paid out of pocket rather than purchasing through their insurance plan.
7700 E. 1st Place, Denver, CO 80230 – direct (303) 856-1367 Dick.Cauchi@ncsl.org Prohibiting PBM “Gag Clauses” that Restrict Pharmacists from Disclosing Price Options:
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