Rep. Bennett Bill Prohibits Prescription Drug Overpayments

Legislation puts the consumer first so they are not burdened by excessive prescription drug costs.

DOVER – Insurance companies and pharmacy benefit managers would be prohibited from overcharging for prescription drugs and pocketing the difference under new legislation introduced Friday by Rep. Andria Bennett.

Known as a “clawback,” insurers and benefit managers are currently able to charge a patient’s co-pay for a prescription drug and keep the difference even if the total cost of the medication is less than the co-pay. Co-pays are a typical part of health insurance plans, but under this clawback practice many patients may be burdened by excessive payments.

House Bill 24 would prohibit clawbacks, and is a companion bill to House Bill 425, which removed the “gag clause” that barred pharmacists from disclosing price options to patients. 

“The rising cost of prescription drugs force Delawareans to make difficult choices every single day: Do I pick up my diabetes medication or pay my rent? I believe that no one should have to make that choice,” said Rep. Bennett, D-Dover South. “Clawbacks are disingenuous and put profit over the patient. This legislation would make sure patients aren’t overburdened by excessive medication costs.”

According to an analysis from the University of Southern California’s Schaeffer Center for Health Policy and Economics that looked at drug reimbursements and large commercial insurer data from 2013, nearly 25 percent of filled pharmacy prescriptions involved a patient co-pay that exceeded the average insurer reimbursement by more than $2, with an average overpayment of nearly $8. The study also noted that total overpayments amounted to $135 million, and were more likely to occur on claims for generic drugs.

According to the National Conference of State Legislatures, at least 20 states have adopted anti-clawback bills, including Maryland, New York and Virginia.