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CMS Sends Clear Message to Plans: Stop Hiding Information from Patients

By CMS on 5/17/2018

CMS Sends Clear Message to Plans: Stop Hiding Information from Patients
Part of the continued roll-out of American Patients First, CMS sends letter to Part D plans explaining that gag clauses that keep patients from knowing how to get the best deal are completely unacceptable

Today, the Centers for Medicare & Medicaid Services (CMS) sent a letter to companies that provide Medicare prescription drug coverage in Part D explaining that so-called “gag clauses” are unacceptable, as part of the Administration-wide “American Patients First” initiative to lower prescription drug costs. 

In Part D, Medicare pays prescription drug plans to cover medicines, which beneficiaries buy at a pharmacy. Gag clauses are provisions in contracts that insurance plans and their pharmacy benefit managers enter into with pharmacies. These clauses prevent pharmacists from telling patients when they could pay less for a drug by paying cash, instead of billing their insurance and paying the required copay or deductible. 

“President Trump and Secretary Azar are committed to lowering drug prices, and CMS today took another important step to help patients who are feeling the pain,” said CMS Administrator Seema Verma. “Many patients don’t know that some drugs are actually more expensive when they use their insurance. What’s worse is that some pharmacy benefits managers are preventing pharmacists from telling patients when this is happening, because they get a share of the transaction when the patient uses their insurance. Today we are taking a significant step towards bringing full transparency to all the back-end deals that are being made at the expense of patients.” 

A copy of the letter that was sent to all Part D Plan Sponsors today is included below, and to learn more about the President’s blueprint to lower prescription drug costs, please visit: http://hhs.gov/drugpricing.

To view Unacceptable Pharmacy Gag Clauses letter click here