Congress has passed and President Trump has signed legislation that bans pharmacist “gag orders.” These gag orders are often included in contracts pharmacies have with insurance companies or pharmacy benefit managers. They prohibit pharmacists from informing patients that they would pay less for their prescription by paying the out-of-pocket cash option than using their insurance. Copayments or coinsurance are more expensive than the cash price for nearly 1 in 4 drugs purchased through the Medicare Part D program.
Under many plans, these cash purchases will not count toward the out-of-pocket maximum, which may discourage individuals from using this option. Plans may consider revising their procedures to allow individuals to apply these cash payments to the out-of-pocket maximum.