3. Eliminating Pharmacist Gag Clauses
The President also took aim at pharmacist gag clauses. According to Shankle, the term "gag clause" is a bit of a misnomer, but generally refers to confidentiality provisions, non-disparagement clauses, and directives on what pharmacists must charge patients after they present insurance that create an atmosphere where pharmacists can't discuss drug costs with patients.
In his speech at the Rose garden, Trump told attendees these gag clauses were "a total rip-off, and we're ending it."
According to Greenleaf, the administration has already acted on this with Medicare Part D plans by sending out a letter stating that pharmacy gag clauses do not comply with the intent of the program.
"That could have some short-term effects preventing or stopping gag clauses for Medicare Part D beneficiaries," she said. "It remains to be seen what will be done on a broader, all patient, nationwide level."
Brow said eliminating the clauses could make substitution easier for generics or lower cost options and would promote a greater level of transparency with patients.
4. Fiduciary Status for PBMs
PBMs have long been criticized for what some view as their opaque business practices. According to NCPA, the blueprint and RFI consider requiring PBMs to act in the best interest of payers.
"NCPA has long supported requiring more regulation of PBMs including acting as a fiduciary," they wrote in a statement about the pricing plan.
According to Shankle, the blueprint outlined how the lack of a fudiciary relationship could result in PBMs making choices that are not in the best interest of the plan, which in turn may not be in the best interest of the payer or consumer.
"It really just kind of demonstrated that having a middle man in the middle that really isn't beholden to anybody isn't doing any favors for any part of the industry," she said.
Improving transparency and enhancing the negotiating practices with PBMs could help improve rising drug prices.
"One of the things that the administration is trying to set up throughout all of this is the environment that encourages the various players in the system, whether it’s drug manufacturers or PBMs or distributors or others, to come to the table and offer solutions," Brow said.
Those who come to the table voluntarily with ideas of how to lower drug prices, he said, may have less risk of government action.