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A simple pharmacy question could unlock savings for millions of Medicare beneficiaries.
Under a little-known Medicare rule, they can pay a lower cash price for prescriptions instead of using their insurance and paying off the amount of the policy. But only if they ask.
This is because pharmacists say that their drug-related contracts often contain "gag orders" that prohibit them from voluntarily publishing this information.
As part of President Donald Trump's plan to reduce the cost of prescription drugs, Medicare officials warned in a letter of May 17 that "gag orders" were "unacceptable and contrary" to the government's efforts to price transparency to promote.
But the authority did not demand that insurers should lift such restrictions on pharmacists.
That does not mean that people with Medicare medicines are doomed to pay too much for prescriptions. You can ask for the lower price, if available, simply by saying Julie Carter, federal policy associate at the Medicare Rights Center, a patient advocacy group.
"If you bring it to the point, then we can inform them about these prices," says Nick Newman, pharmacist and manager at Essentra Pharmacy in rural Marengo, Ohio. "It's a moral dilemma for the pharmacist to know what's best for the patient, but not to be able to help them and hope they ask you about the comparison."
For consumers who tend to retail, details can be difficult to find: Medicare's website and annual manual do not mention it.
"If you do not know that there are a number of different prices that could be available in any pharmacy, you do not know what you do not know," says Leigh Purvis, director of the AARP Public Policy Institute of Health Services Research.
Researchers who analyzed 9.5 million part D prescription claims reported in a research letter JAMA in March that a patient's co-payment was higher In 12 of the 20 most commonly prescribed medications, patients were too close over 33 percent overpaid.
Although the study found that the average overpayment for a single regulation was relatively low, Newma He says he has seen consumers pay up to $ 30 more than the cash price.
And many beneficiaries may not know this when they pay a lower amount of cash for a covered drug in a pharmacy that subscribes to their insurance and then, after proper documentation, insurers must bill the expenses. The sum of these expenditures can trigger the gap in drogue coverage, commonly referred to as a donut hole. (This year, the gap begins after the plan and beneficiary spend $ 3,750 and ends once the beneficiary has spent $ 5,000 in total.)
Daniel Nam, executive director of federal programs for America's Health Insurance, Agrees with this "Patients should have access to the lowest possible price in the pharmacy." But he says the Medicare warning is aimed at an increasingly rare event. Gag order clauses are "not something they include in their contracts," he says.
UnitedHealthcare, whose popular prescription drug plans dominate the market, does not include them in any of its Medicare, Medicaid or commercial insurance contracts, says Matt Burns, a corporate spokesman.
Pharmacy benefit managers also say that gag orders are not typical. "If it happens, it's an outlier," says Mark Merritt, president and CEO of the Pharmaceutical Care Management Association.
However, some pharmacists disagree. Kala Shankle, Policy and Regulatory Affairs Director for the National Community Pharmacists Association, which represents 22,000 independent pharmacies, said insurers have punished pharmacists who violate gag orders by dropping them off the plan's network.
In Ohio, one of several states that have responded to complaints about the problem in health insurance contracts, including some Medicare drug plans.
"The department has received inquiries that concern companies that retain cost-saving information from consumers, which sometimes results in an insured person paying more pharmacy benefits than the actual cost of such pharmacy benefits," wrote the Ohio Department of Insurance last month.
Illinois and Ohio State legislators are considering bills making these restrictions illegal, and similar legislation has been introduced in the US Senate.  "If we did not have those gagging clauses, there would be no need for legislation and politics would change the movement going on in the country," says Garth Reynolds, executive director of the Illinois Pharmacists Association.
Kaiser Health News, a non-profit news service and editorially independent program of the Kaiser Family Foundation not affiliated with Kaiser Permanente.