Recent History of the Gag Clause Revisited

With the passage of the 2018 New York State Budget, pharmacists could discuss price options with patients including less expensive therapeutic equivalents and alternatives to copays without being penalized by PBMs. It expanded on Section §6826-a. Reducing certain copayments of the Education Law which reads:

1. Where an insured's copayment for a drug exceeds the corresponding retail price for the same drug on the pharmacy's drug retail price list, the pharmacist shall notify the insured of this occurrence and charge no greater than the pharmacy's corresponding retail price.
2. Where the drug being purchased is not on the drug retail price list, and the copayment for the drug exceeds the pharmacy's usual and customary price for that drug, the pharmacist shall notify the insured of this occurrence and charge the lesser of the insured's copayment and the pharmacy's usual and customary price for that drug.

The current Senate Bill in 2024 improves upon the 2018 legislation. The 2024 Gag Clause Legislation allows pharmacists to discuss their reimbursement rates and how reimbursement rates may be contributing to the difficulty in obtaining a needed medication. Greater transparency can only be beneficial for the patient.