Gene Ransom: The Gag rule needs to be broken

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Physicians and other medical health professionals share concern with their patient’s over the rising cost of healthcare. As insurance premiums, co-pays and deductibles continue to rise, patients feel the pain, and they feel it acutely at their local pharmacy counter. A regimen of life-changing prescription medications should not be a source of stress and anxiety. That's why The Maryland State Medical Society (MedChi) supports state legislation sponsored by Delegate Bromwell and Senator Klausmeir to eliminate the "gag rule" that prevents pharmacists from telling patients when the out-of-pocket cost of their prescription drug would cost less than their insurance co-pay. (SB 576 / HB 736)

At a time where many drug prices are actually stabilizing, out-of-pocket patient costs continue to rise. The causes of the out of pocket increases are complicated. One issue related to drug costs is the “gag rule.” Insurance companies actually set the price for what most patients pay at the counter and to further complicate matters, companies known as "pharmacy benefit managers, or PBMs, are an additional "middle man" between the drug companies and your pharmacy. The PBMs have made rules that prevent pharmacist from telling patients about lower cost options. With those rules called the “gag rule or gag clause” a PBM insurance contract prevents a pharmacist from telling a patient about a lower cost option to purchase the medicine.

While health care delivery is complicated, we should all support common sense measures to make healthcare more affordable like eliminating the gag rule placed on pharmacists. Patients should not be forced to pay more simply because they lack the knowledge of lower cost options, and the people with the knowledge are banned from sharing.

The General Assembly should be supported as they are close to passing this important legislation to protect patients at the pharmacy counter, and improve the public health of Maryland.

Gene M. Ransom III, CEO MedChi, The Maryland State Medical Society, Twitter: @generansom, Email:

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