Prescription Drug Clawbacks Under Fire From Lawmakers, Lawyers

A controversial health insurance practice that critics say ratchets up the cost of prescription drugs may be on the chopping block as it gains more attention from attorneys, academics, and lawmakers.

A flurry of lawsuits over prescription drug “clawbacks” filled federal court dockets in recent years, with cases targeting UnitedHealth, Cigna, Humana, and OptumRX. A recent legal victory in the case against Cigna could force the insurer to disclose information about its alleged clawback practices, which could chip away at the lack of transparency that critics say allows the practice to proliferate. The March 12 court ruling comes on the heels of the first significant academic research on clawbacks, which suggests they could be occurring in about a quarter of all insured drug sales.

Legislators at both the state and federal levels are paying closer attention to clawbacks. On March 14, Sens. Susan Collins (R-Maine), Claire McCaskill (D-Mo.), Debbie Stabenow (D-Mich.), and Bill Cassidy (R-La.) introduced legislation that would ban the “gag clauses” preventing pharmacists from telling insured customers when they could save money by paying for their prescriptions in cash. Several states, including Connecticut, Texas, and Georgia, have passed legislation attempting to rein in clawbacks.

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