by Brian Scott-Smith CTNewsJunkie

Starting in October, millions of Americans will be able to see drug price comparisons, view out-of-pocket costs, and access prior authorization requirements with the help of their physician.

The US Department of Health and Human Services (HHS) recently announced the change, which will give doctors and patients unprecedented real-time access to prescription drug information, according to the department.

The change will, “help identify the most appropriate, cost-effective treatments while preventing health insurers from blocking physician-approved care,” according to the department.

State Sen. Saud Anwar, D-South Windsor, a physician, said the new regulations could be useful, but said that until he sees the system in action, just how useful remains to be seen.

Anwar said it was frustrating for him as a doctor and potentially dangerous for patients when health insurers, who do not have the same relationship with a patient as he does, make decisions based solely on price, rather than considering whether the medication is the best one to treat the patient’s problem.

Anwar said the changes would help some patients more than others.

“If you pay for health insurance or happen to be fortunate to have health insurance, that’s fine, but if you have no health insurance or you’re a low-income worker, it’s unlikely you’ll benefit from this,” he said.

He cited the Pharmacy Benefit Managers (PBMs), who are the middlemen that set the prices for the drugs used by every American.

“No where else in the world, other than the US, has this type of system and we all know we’re paying too much for medications and healthcare in this country as a result,” he said.

Greg McKenna, owner of a small chain of independent pharmacies in Connecticut in Middlesex and New London counties, agreed.

“Not only should we show costs in the United States, we should show pricing from around the world,” says McKenna.

McKenna said until a few years ago pharmacy owners like him weren’t even allowed to discuss drug pricing and alternatives with their customers because of specific contract language in their various PBM contracts that forbade them from doing so under threat of having that PBM’s contract canceled if they did.

“People should not only see the price we pay but also the amounts the PBMs take,” McKenna said.

There are positives  in the new system for patients and doctors, McKenna said, but pharmacies like his, he said, would still be underpaid.

Under the new Medicare Transaction Facilitator Program, a pharmacy will get paid by the PBM the government-negotiated lower cost for filling and dispensing previously negotiated prescription drugs.

He says there’s a complex system of claims retrieval, review, and then recoupment between the government-negotiated price and the current price of the drug.

In simple terms McKenna said the government has failed in their negotiations to make sure that pharmacies are made whole in the process, as the PBMs will use the higher price still for their clawbacks, but only pay pharmacies the lower negotiated price for dispensing drugs regardless of who the patient is, be they Medicare or not.

He says the drug companies also win because they only have to lower the price of certain drugs for Medicare recipients and not for everyone.

Connecticut residents who are not Medicare recipients can find some cost relief on their prescription medications by using a service rolled out by the State Comptroller’s Office called ArrayRX.

The online service, used by Connecticut, Nevada, Oregon and Washington state, can provide discounts up to 80% on medications. All FDA-approved prescriptions are eligible under the program.