Ohio Now Requiring Transparency on Prescription Drug Pricing

April 6, 2018

Ohio Department of Insurance Director Jillian Froment has issued a bulletin requiring heightened protections for Ohio consumers related to prescription drug prices.

The bulletin requires insurers and pharmacy benefit managers (PBMs) to remove the “gag order” that prevents disclosing to consumers the most affordable prescription drug option available to them.

Currently, some insurers and PBMs use contractual provisions to prevent pharmacists from discussing with consumers if other options are available to purchase their prescriptions at a lower cost. This bulletin would prohibit that practice.

In addition, the bulletin prohibits health insurers and PBMs from charging consumers more for their prescription drugs than what it would otherwise cost without insurance coverage.

With the “gag order” removed, pharmacists would be free to discuss affordable options with consumers and consumers would be charged the lesser of their co-pay or the cost of the drug. For example, if a consumer has a $20 co-pay for a prescription that only costs $10 if purchased without insurance, the consumer must be charged the lesser amount.

“Consumers have a right to better understand the cost of their prescription drugs and whether or not they can get those prescriptions filled at a lower cost,” Froment said in the department’s release. “We require insurers and pharmacy benefit managers to act in good faith and to follow Ohio law, but these explicit prohibitions will make expectations clear and will protect Ohio consumers.”

Bulletin 2018-02 has been posted to the Ohio Department of Insurance’s website and takes effect immediately.

Source: Ohio Department of Insurance

Topics Ohio

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