Federal Legislation
On the federal level, U.S. Senators Susan Collins (R-ME) and Claire McCaskill (D-MO) drafted The Patient Right to Know Drug Prices Act, which would prohibit an insurer or pharmacy benefit manager from restricting a pharmacy’s ability to provide drug price information to a plan enrollee when there is a difference between the cost of the drug under the plan and the cost of the drug when purchased without insurance. This bill would apply to plans offered through exchanges and by private employers.
The U.S. Senate passed S. 2554, the Patient Right to Know Drug Prices Act, by a vote of 98-2.
In relevant part, the bill reads:
SEC. 2729. INFORMATION ON PRESCRIPTION DRUGS.
A group health plan or a health insurance issuer offering group or individual health insurance coverage shall—
not restrict, directly or indirectly, any pharmacy that dispenses a prescription drug to an enrollee in the plan or coverage from informing (or penalize such pharmacy for informing) an enrollee of any differential between the enrollee’s out-of-pocket cost under the plan or coverage with respect to acquisition of the drug and the amount an individual would pay for acquisition of the drug without using any health plan or health insurance coverage; and
ensure that any entity that provides pharmacy benefits management services under a contract with any such health plan or health insurance coverage does not, with respect to such plan or coverage, restrict, directly or indirectly, a pharmacy that dispenses a prescription drug from informing (or penalize such pharmacy for informing) an enrollee of any differential between the enrollee’s out-of-pocket cost under the plan or coverage with respect to acquisition of the drug and the amount an individual would pay for acquisition of the drug without using any health plan or health insurance coverage.
Broad Physician and Pharmacist Support for S. 2554
Senators Barrasso (R-WY), Stabenow (D-MI), and Cassidy (R-LA) joined Senators Collins and McCaskill in introducing the Patient Right to Know Drug Prices Act in March. It was also co-sponsored by Senators Tina Smith (D-MN), Joe Donnelly (D-IN), Dianne Feinstein (D-CA), Lisa Murkowski (R-AK), Bob Menendez (D-NJ), Tammy Baldwin (D-WI), John Kennedy (R-LA), Maggie Hassan (D-NH), Richard Blumenthal (D-CT), Roger Wicker (R-MS), Shelley Moore Capito (R-WV), Heidi Heitkamp (D-ND), Deb Fischer (R-NE), Lamar Alexander (R-TN), John Boozman (R-AR), Angus King (I-ME), Sherrod Brown (D-OH), Martin Heinrich (D-NM), Chuck Grassley (R-IA), and Tom Udall (D-NM).
More than 40 organizations supported this legislation, including the National Community Pharmacists Association (NCPA), the American Medical Association, the Alliance for Transparent and Affordable Prescriptions, the ERISA Industry Committee, the Pharmaceutical Care Management Association, and America’s Health Insurance Plans.
The Pharmaceutical Care Management Association has stated, “We support the patient always paying the lowest cost at the pharmacy counter, whether it’s the cash price or the copay. We would oppose contracting that prohibits drugstores from sharing with patients the cash price they charge for each drug.”
