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Blue Cross Executive Backs Ban on Drug Benefits Gag Clauses

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An executive who helps manage federal employees’ own health benefits says increased transparency would be a great treatment for high prescription drug costs.

The executive, David Yoder, testified Wednesday at a House Energy and Commerce health subcommittee hearing. The subcommittee organized the hearing to look for ways to improve health care. Yoder was the only witness who spoke on behalf of participants in the commercial health insurance market.

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Yoder is executive director for member care and benefits at the Blue Cross Blue Shield Association (BCBSA) federal employees’ program. The association is one of the major providers of coverage options through the Federal Employees Health Benefits Program.

One of  the issues Yoder addressed is reports that some health plans, and drug plans, use gag clauses, to keep pharmacists from telling customers about ways the customers might be able to cut what they pay out of pocket for medicine.

Yoder said that he does not think that any of the Blues, or any outside pharmacy benefits managers (PBMs) administering drug plans on their behalf, use gag clauses.

“The BCBSA does not support the use of gag clauses,” Yoder said at the hearing, which was streamed live on the web. “Full transparency is critical.”

In written testimony, Yoder said the BCBSA supports legislation that would ban gag clauses. The association would also support encouraging pharmacists to tell customers about treatments that might be cheaper than what the customers are seeking, as long as the pharmacists do so while in direct communication with the dispensing physician.

In the written testimony, Yoder also said that insurers themselves need more transparency from the drug makers.

“There should be transparency regarding the pricing of prescription medicines,” Yoder said in the written testimony. “Specifically, information about a drug’s price and its effectiveness should be widely available to the public. It is also important that health insurers know which new drugs are coming into the pipeline. This allows health insurers to work with doctors and pharmacists in planning and in working to ensure there are ways to get prescription medicines to patients at the most affordable cost.”


Links to more information, including a link to a video recording of the hearing, and links to the written versions of the witnesses’ testimony, are available here.

— Read Aetna Will Pass Along Discounts as Drug Price Scrutiny Increaseson ThinkAdvisor.

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