Pharmacy 'gag rules' under more scrutiny

So-called gag rules bar pharmacists from telling patients when they could save by paying cash instead of using insurance. The rules are receiving new scrutiny after President Donald Trump singled them out for criticism in his plan for lowering drug prices. "This is a total rip-off and we are ending it," Trump said of the practice.

So-called gag rules bar pharmacists from telling patients when they could save by paying cash instead of using insurance. The rules are receiving new scrutiny after President Donald Trump singled them out for criticism in his plan for lowering drug prices. "This is a total rip-off and we are ending it," Trump said of the practice. The gag rules are included in contracts between pharmacies and PBMs. "When it comes down to making sure the patient can afford their medication, the gag clause prevents us from having that conversation so they can make the best informed decision," said Randy McDonough, an Iowa pharmacist. A 2016 industry survey found that nearly 20% of pharmacists were limited by gag clauses more than 50 times per month. Andy Soileau, a Louisiana pharmacist, recently testified before state lawmakers about the issue. He cited an example of a customer who was required to pay a $50 copay for generic birth control pills that would have cost $18 without insurance. In May, Louisiana became the latest of nearly 20 states to ban the restrictions. Stephen Schondelmeyer, who studies pharmaceutical economics at the University of Minnesota, said PBMs tell pharmacists: "If we catch you telling patients you can buy this cheaper for cash we will kick your pharmacy out of our network."