LDN - Health and Fitness

Ohio regulator orders insurers, benefit managers to give lowest drug price

[April 05, 2018] By Caroline Humer

(Reuters) - The Ohio Department of Insurance said on Wednesday that pharmacy benefit managers and insurers would have to disclose the lowest price for a prescription drug for Ohio consumers, part of a move to prevent insured consumers potentially paying more than those without insurance.

Two of the largest pharmacy benefit managers, Express Scripts Holding Co. and CVS Health Inc said their contracts include clauses by which members receive the lowest cost automatically.

"We do not engage in this anti-consumer practice and are working constructively with state and federal policymakers to ban the practice," Express Scripts spokesman Phil Blando said in a statement.

U.S. lawmakers introduced legislation last month called the "Patient Right to Know Drug Prices Act" and the "Know the Lowest Price Act of 2018", both aimed at preventing companies from instituting so called "gag clauses" in contracts.

The agency said it would ban the practice in which some insurers and pharmacy benefit managers use contractual provisions to prevent pharmacists from discussing with consumers if low-cost options are available for prescriptions, effective immediately.

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It would also prohibit them from charging customers a higher amount for prescription drugs than what it would otherwise cost without insurance coverage.

CVS last month said in a statement after those bills were introduced that its pharmacy benefit members always get the benefit of the lower price.

"If a CVS Caremark plan member's copay for a drug is greater than the dispensing pharmacy's contracted rate, it is not our practice to collect that difference from the pharmacy," it said.

OptumRx, the pharmacy benefit division of UnitedHealth Group Inc was not immediately available for comment.

(Reporting by Caroline Humer in New York and Arjun Panchadar in Bengaluru; Editing by Susan Thomas)

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