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Access to MS Medications Bills Advance to President

October 4, 2018

Update: On October 10, 2018 the President signed into law S. 2553 the Know the Lowest Price Act of 2018, and S. 2554 the Patient Right to Know Drug Prices Act.

On September 25, 2018, the U.S. House of Representatives passed two bills that prohibit insurers and pharmacy-benefit managers (PBMs) from preventing pharmacists from informing patients they could potentially save money on their prescriptions by paying cash instead of an insurance copayment. These bills are S. 2553 and S. 2554, and they were drafted in response to the growing trend of PBMs and insurers inserting gag clauses in their contracts with pharmacists that prohibit the pharmacists from giving patients more complete and transparent information about the prescription drugs they’re buying at the pharmacy. The U.S. Senate has already passed these bills and they are headed to the President’s desk for his signature.

The National MS Society supports the banning of gag clauses as they align with the Society’s Access to MS Medications Recommendations. The Recommendations call for increased transparency throughout the pharmaceutical system and supply chain—from manufacturers, insurers and PBMs, among others. However, determining the role that pharmacy benefit managers play in prescription drug pricing and consumer access is currently difficult given the lack of information that is publicly available. 

In recent years it has become apparent that consumers may be paying more than the actual cost of their medication (the price negotiated by the PBM) at the pharmacy. Pharmacists who violated the contract with PBMs could have been penalized with fees or pulled from the network. This issue tends to affect access to symptom-management medications, which people living with MS may commonly purchase via a local pharmacy, more than disease-modifying therapies.

Congress also passed its opioids package titled “The Opioid Crisis Response Act of 2018”, which includes a change in policy that will allow Medicare and Medicare Advantage beneficiaries to obtain electronic prior authorization for drugs covered by Part D. This will require electronic prior authorizations to use a standard format with the objective of streamlining the prior authorization process and reducing the burden that prior authorizations place on both patients and providers. This will reduce the number of barriers that stand between people living with MS and the medications that they rely upon to live their best lives.

Learn more about access to MS medications bills moving through Congress.

About Multiple Sclerosis

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. Symptoms range from numbness and tingling to blindness and paralysis. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are leading to better understanding and moving us closer to a world free of MS. Most people with MS are diagnosed between the ages of 20 and 50, with at least two to three times more women than men being diagnosed with the disease. MS affects more than 2.3 million people worldwide.

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