States across the country are moving to block "gag clauses" that prohibit pharmacists from telling customers that they could save money by paying cash for prescription drugs rather than using their health insurance. Many pharmacists have expressed frustration about such provisions in their contracts with PBMs. At least five states have adopted laws to make sure pharmacists can inform patients about less costly ways to obtain their medicines, and at least a dozen others are considering legislation to prohibit gag clauses, according to the National Conference of State Legislatures. Sen. Susan Collins (R-ME), said that after meeting recently with a group of pharmacists in her state, she was "outraged" to learn about the gag orders. "I can't tell you how frustrated these pharmacists were that they were unable to give that information to their customers, who they knew were struggling to pay a high copay," Collins said. HHS Secretary Alex Azar agreed, stating "That shouldn't be happening." However, Thomas E. Menighan, CEO of APhA, said that such clauses are "not an outlier," but instead a relatively common practice. Under many contracts, he said, "the pharmacist cannot volunteer the fact that a medicine is less expensive if you pay the cash price and we don't run it through your health plan."