New Law Bans Deceptive “Clawback” Practice
By Shaina Smith.
In what appeared to Connecticut pain patients as a reluctance streak from the Governor’s office to take a stand against insurers has now taken a positive turn for the state. That’s thanks to Governor Dannel Malloy, who recently signed Senate Bill 445 into law, bringing control of treatment options back into the hands of individuals.
In just a little over one month following the close of Connecticut’s legislative session, Gov. Malloy agreed to sign the patient-friendly legislation, An Act Concerning Fairness in Pharmacy and Pharmacy Benefits Manger Contracts. The legislation, championed by Senators Martin Looney and Leonard Fasano, had come under fire towards the end of session, when the Governor publicly scolded the two Senators in a form of a letter to the media. He noted that he felt the Senators were taken an “unnecessarily antagonistic approach towards Connecticut’s insurance industry.” The Governor did note that he was in favor of SB 445, but not the approach by which the legislation was developed. Despite the public comments made by the Governor, the bipartisan bill unanimously passed the Senate and passed the House in a vote 127-22.
Governor Malloy did not silently sign the legislation, however. In a letter sent to all legislators, Gov. Malloy noted his support for the bill, but was concerned his previous recommendations were disregarded. Calling the process isolated, the Governor urged supporters of the bill to “open their doors to a variety of perspectives.”
Under SB 445, existing “gag clauses” in pharmacy benefit manager (PBM) contracts that prohibited pharmacists from providing all medical and financial options with patients will now be lifted. Previously, Connecticut residents were not protected by practice used by PBMs to profit from over-charging enrollees for their prescription medicines. Prior to the signage of SB 445, a pharmacist was not allowed to disclose any and all cost savings available to patients. Instead, “gag clauses” were found within the contracts between the pharmacists and PBMs, allowing pharmacists to be reimbursed at the normal rate of the drug, PBM’s making a profit off of the necessary medications and patients incurring all the costs.
By banning PBMs from prohibiting pharmacists from disclosing information about all available options for pain patients, Connecticut residents who rely on essential and even life-saving medications will be able to access such modalities without being forced to overpay. The law will also ensure patients are not being over-charged and/or facing financial difficulty in accessing medications which manages the complex disease of chronic pain.
U.S. Pain Foundation acknowledges that the legislation will provide patients the opportunity to access medically necessary treatment options without impeding financial barriers. Legitimate chronic pain patients will not longer be withheld from information that could allow them to financially access medically necessary treatment options. Passage of Senate Bill 445 into law is a significant win for those within the state living with a rare and/or incurable chronic pain condition. It also stands to save patients, insurers and the health care system money.
Shaina Smith is a patient advocate and serves as Director of State Advocacy & Alliance Development for U.S. Pain Foundation. Through the organization, she has learned to live with pain and not in pain stemming from her condition, Ehlers-Danlos Syndrome.