What is the Pharmacy Gag Rule?

What is the pharmacy gag rule and why should I care? Is it because the medicine has a bad taste? Does the gag rule affect my Medicare Part D coverage? GA Medicare expert Bob Vineyard answers your questions.

pharmacy gag rule
What is the Pharmacy Gag Rule?

The pharmacy gag rule existed in a handful of states prior to October, 2018. It works like this.

You take a prescription to your pharmacy. If you ask the druggist about a lower price he/she was prohibited from telling you how to save money where the gag rule was in place.

The result, you pay more for your medication when you use insurance.

What is the Pharmacy Gag Rule?

How Does the Gag Rule Affect Me?

Essentially you pay more for your drugs than you should.

A recent study by JAMA indicates people with Medicare Part D drug insurance overpaid for prescriptions by $135 million in 2013. Copayments in those plans were higher than the cash price for nearly 1 in 4 drugs purchased in 2013. For 12 of the 20 most commonly prescribed drugs, patients overpaid by more than 33 percent.KHN

That’s more than just sofa change. Seniors on a fixed income need to hang on to as much of their money as possible.

Some folks, like Steve Knievel, considers $135 million “falling short of where it needs to be”

As a nation we spend $450 million on prescription medications. I think cutting costs by 25% to be significant.

Good News – Bad News

First the good news.

People on Medicare can see the impact of the pharmacy gag rule next year. As of January 1, 2020 a senior on Medicare is entitled to know if they can get their drugs for less by paying cash.

Pharmacists are allowed to tell you how to save money without using your Part D card.

Now the bad news.

Just because a druggist CAN tell you about lower prices does not mean they WILL tell you.

If you want to save money you will have to ask . . .

You can also save money by checking out Free and Low Cost Prescription Drugs.

But if You Like Paying Too Much . . .

You can always use your Part D plan.

GA Medicare expert Bob Vineyard has over 500 clients in Georgia. He specializes in explaining how to save money on prescription medications.

There is no pharmacy gag rule that can keep him quiet.

Georgia Medicare Plans YouTube Channel has several videos explaining how Medicare Part D works. Here are just a few things you can learn.

  • Choose a Part D plan that has a deductible
  • Use preferred pharmacy’s
  • Ask your doctor about generic alternatives
  • Pay cash for generic drugs
  • Use a discount card like GoodRx for generics
  • Consider buying brand names by mail from Canada

Every year we review our clients current drug plan and compare it to the new plans for the following year. Almost every time our clients will save money. An average of $60 per month.

Two years ago we saved one client over $600 per month and another over $700 per month.

A few weeks ago we showed a client how to cut his prescription eye medications from $800 to less than $250.

Let’s face it. Medicare Part D is confusing. But it doesn’t have to be.

How much can you save?

The pharmacy gag rule never kept us from telling our Medicare supplement clients how to save money.

Medicare Part D – Choosing the Right Plan for You

Georgia Medicare Part D Plans vary greatly. When you select the best Georgia Medicare Part D Plans should you include Medicare prescription drug plan benefits? Finding the best GA prescription drug plan is not as simple as you may think. Do you contact Medicare? Or will a health insurance company or Georgia agent give the best advice? (Updated 11/6/2017)

Medicare Part D - Choosing the Right Plan For You


With all the options for prescription drug plans in GA, becoming confused about uncovering the best plan for you is common. Do you choose the plan endorsed by a large senior advocate association? Or do you buy a plan advertised on TV commercials

Where will you turn?


Medicare Part D – Choosing the RIGHT Plan

Mary Searches for an Affordable Drug Plan

Turning 65, Mary signed up for Medicare A and Part B. Then she bought a popular Medicare supplement plan G from an agent in Georgia. The agent was highly recommended by a neighbor who was also a dear friend. Bob took the time to discuss all options and help her choose the best plan for her needs and budget.

Saving money and living on a budget is important to Mary. She asks Bob “how do I find the best Part D, prescription drug plan?”

His answer totally caught her off guard. Bob tells Mary she should not talk to an insurance agent, or call a carrier and speak with them. Why not talk to an agent? Don’t they know about all the plans? Most agents will only tell you about plans that pay them a commission.

In 2017 there are 24 Part D plans but most agents will only show you 3 or 4. Those are the plans that pay them a commission (about $1.50 per month). What about the other 20 or so plans?

Those agents will never bring them up.

Bob Vineyard at Georgia Medicare Plans does things differently. He will take your drug information and run reports on Medicare.gov. You can do this yourself but why not allow someone that does this every day handle it for you? We run over 600 reports like this every year, but only for our Medigap clients. We review the report with you and show you the best combination of carrier and pharmacy that produces the lowest overall cost. Then we tell you how to enroll direct with the carrier.

How easy is that?



Prescription Drug Plans and Supplemental Medicare Insurance

Georgia Medicare Plans specializes in Medicare supplement plans. With over 400 clients all over the state we don’t have a single one that has a Medicare Advantage plan. We find most folks that bought their Medigap plan from anotther agent, direct from a carrier, or from an association for retired people have the wrong plan and are paying too much. We do things differently.

If you like our approach give us a call. We will be glad to send you a report showing ALL the Medigap plans and rates in your area.

 #MedicareDrugPlans #MedicarePartD #MedicareSupplementRates #Turning65