Follow facebook twitter google   

What exactly are pharmacy gag rules? How can I get around gag rules?

 

Question:
What exactly are pharmacy gag rules? How can I get around gag rules?

Answer:

Put in place by pharmacy benefit managers (PBMs), such as Express Scripts and CVS Caremark, gag rules prevent pharmacists from disclosing possible savings for patients at the pharmacy counter. The "gag" is inserted in contracts between a pharmacy and a PBM.

 

It's quite possible that paying cash for your medication instead of using insurance could save you a lot of money. Your pharmacist might know this but, due to gag rules, can't inform you that your copay exceeds your drug's cash price — unless you ask! These rules can also bar pharmacists from telling patients and caregivers about cheaper, generic drug options.

 

How can I get around gag clauses?

 

Unless you specifically ask about savings information at the pharmacy counter, your pharmacist may very well remain silent. So ask. If you do, then they must respond. Here's what to do specifically:

 

  1. Always ask the pharmacist for the cash price of the drug. 
  2. Always ask if there is a cheaper, generic alternative.
  3. Shop around. Some pharmacies offer lower cash prices than others for numerous generic drugs. You can use PharmacyChecker.com to research cash prices at U.S. pharmacies. Just scroll to the bottom of your needed drug's price page and enter your zip code to find the discounts available in your area. When you choose a pharmacy, click "Print Card for This Pharmacy" and you are all set to obtain your discount at the pharmacy of your choice.
  4. Compare prices at verified international online pharmacies.

 

Advocacy

 

Gag rules make it more likely that Americans won't be able to adhere to taking their medications as prescribed. For many Americans, prescription costs are a matter of life and death.

 

The higher the out-of-pocket spending, the less likely patients will adhere to filling their prescriptions.

 

PharmacyChecker advocates for expanding consumer access to safe, effective and affordable medications. We believe that it's completely unacceptable and unnecessary for tens of millions of Americans to skip filling prescriptions each year because of cost — and yet they do: 45 million in 2016. When the cost of life-saving medications becomes unaffordable locally, consumers should have online access to lower-cost medications in Canada and other countries.

 

If you have a story to tell about your experiences with high drug prices, then please write to us at yourstories@pharmacychecker.com.

 

Published 6/19/2018




COMMENTS



Share your comments about our answer to this question in the space below. Please abide by the following rules and principles:
  • Comments that are discriminatory on matters of race, religion, gender, sexual orientation, or ethnicity will be deleted.
  • Please be courteous and respectful in your tone.
  • Please stick to the subject matter of the specific PharmacyChecker.com answer to which you are posting a comment.
  • Please do not submit any type of HTML markup or scripting as it will not be accepted.
Comment:

Sending...
Share your comments about our answer to this question in the space below. Please abide by the following rules and principles:
  • Comments that are discriminatory on matters of race, religion, gender, sexual orientation, or ethnicity will be deleted.
  • Please be courteous and respectful in your tone.
  • Please stick to the subject matter of the specific PharmacyChecker.com answer to which you are posting a comment.
  • Please do not submit any type of HTML markup or scripting as it will not be accepted.
Comment:

Sending...
You can modify your comment below. Please be aware the comment will have to approve the changes before they will be shown:

Comment:

Sending...
Your edit has been submitted and is being reviewed by ConsumerLab.com prior to publication.
To leave a comment, you'll need to be registered with us. Sign in below.
Email Address:
Password:        forgot password?
Not registered? Sign up HERE.
*If you do not receive a confirmation email from PharmacyChecker, please check your spam folder.
Please provide your email below and press "Send Password".
Email Address:
  

Back to Login.
Register to submit comments to PharmacyChecker.com
First Name:
Last Name:
Email Address:
Password:
Confirm Password:


If you are already registered, click HERE to sign in.
*We do not share or sell your personal information with anyone else, ever

Join the Discussion

SEARCH ANSWERS

Our Panel of Experts

Tod Cooperman, MD

Chief Executive Officer and Founder
Tod Cooperman Dr. Tod Cooperman is a noted researcher, writer, and speaker on consumer healthcare issues.

Gabriel Levitt, MA

President and Co-founder
Gabriel Levitt Mr. Levitt oversees all business operations, development and research. He is a public advocate for prescription drug affordability.

Shivam Patel, PharmD, BSPS, RPh

Director of Pharmacy Verification and Information
Shivam Patel Dr. Patel provides expert knowledge regarding safe pharmacy practice, quality assurance, drug safety, and patient access to affordable medication.
Read More About Our Team

Disclaimer

Disclaimer: The information provided on Ask PharmacyChecker is neither intended nor implied to be a substitute for professional medical advice, nor is it an endorsement of any product or service. If you are considering purchasing medication from outside the U.S., be aware that, in most circumstances, it is technically not legal for individuals to import prescription drugs; however, U.S. government officials have stated that individuals who order non-controlled prescription drugs from Canada or other foreign sources (up to a three-month supply) for their own use are not being pursued or prosecuted.