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Ask an Expert: Paying Cash For Your Prescription May Be Less Expensive Than Insurance

If your health insurance covers prescriptions, you likely always use your benefits to purchase medications. But did you know that sometimes it might be less expensive to pay cash?

Many patients have no idea, and until recently, some pharmacists were unable to point out the potential cost savings to patients. So-called “gag order” clauses in contracts between pharmacies and insurance companies prohibit pharmacists from telling customers when they can save money by paying the pharmacy’s lower cash price instead of the price negotiated by their insurance plan.

Know the Lowest Price Act of 2018

Soon pharmacists will be free to discuss cash pricing with their patients. On October 10, 2018, President Trump signed the Know the Lowest Price Act and the Patient Right to Know Drug Prices Act. These legislations ban Medicare Advantage plan providers, providers of Medicare Part D prescription drug plans , and commercial health plans from including “gag orders” in their contracts with pharmacies. The law will go into effect January 1, 2020.

It is important to note that under the new legislation, pharmacists will not be required to tell patients about the lower cost option. Many will be excited to have the discussion as a way to help patients, but there is no rule saying they have to. That is why it is so important for patients to feel comfortable asking questions at the pharmacy counter .

Payment and Savings Options for Rx Drugs

As a patient, it never hurts to ask about a lower Rx price at the pharmacy. Sometimes the lowest price may mean paying cash for your prescription. In other situations, pharmacy discount cards may offer a lower price than your health plan. Pharmaceutical manufacturers’ coupons are another great way to get medication discounts with or without insurance coverage .

Looking Ahead

More legislative changes could come in the future as well. For example, federal officials are debating forcing pharmaceutical companies to disclose list prices of prescription drugs in their television advertising, in an effort to push transparency in the industry. The New York Times reports that those involved are comparing the proposed regulations to longstanding requirements for automakers to disclose sticker prices.

All of this news is a great reminder that there are many different ways for patients to afford their medications, whether they use health insurance or not.

This post is part of our “Ask an Expert” blog series by Ken Majkowski, Pharm.D, the Chief Pharmacy Officer at FamilyWize. Ken brings more than 40 years of healthcare experience to the FamilyWize team, including 14 years of clinical pharmacy experience in retail, hospital, and home care. Read his full bio here .

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