CMS to Medicare Drug Plans: ‘Gag Clauses Unacceptable’

Medicare Part D prescription drug plans should not prevent pharmacies from telling customers when they could pay less for a drug by paying cash, the Centers for Medicare & Medicaid Services told plan sponsors yesterday. “An important step in putting patients first and lowering out-of-pocket costs is addressing ‘gag clauses’ that some health plans and pharmacy benefit managers include in their contracts with pharmacies,” the memo states. “…We want to make it clear that CMS finds any form of ‘gag clauses’ unacceptable and contrary to our efforts to promote drug price transparency and lower drug prices. We also remind Part D plan sponsors that they must require their network pharmacies to disclose any differential between the price of a Part D drug and the price of the lowest cost therapeutically-equivalent generic version of that Part D drug.”