Between the lines on insurers and drug rebates image

Axios Vitals, March 28, 2018
Sam Baker, citing Rachel E. Sachs (Academic Fellow Alumna)

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From the article:

UnitedHealthcare and Aetna have committed to lowering some consumers' out-of-pocket drug costs by sharing the rebates that pharmacy benefit managers (PBMs) negotiate with drug companies. More insurers may follow, but the announcements also raise some questions, per my colleague Bob Herman.

If patients pay less at the pharmacy counter, will insurers hike premiums to offset the discount?

  • Yeah, probably. Aetna spokesman T.J. Crawford told Bob: “Given the fact that the majority of rebates are currently passed on to plan sponsors and their employees through lower premiums, yes — this decision could result in higher premiums.”

With that in mind, will point-of-sale rebates ultimately help lower what the country pays for prescription drugs?

Why stop now? Aetna and United are making this option available for subsets of their members. But both companies strongly oppose doing the same thing for Medicare's drug benefit.

  • Aetna argued the effects within Medicare would be different than in the employer market, because sicker Medicare patients who use high-cost drugs could flock to standalone Part D plans that negotiate the biggest rebates.

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health care finance health care reform health law policy pharmaceuticals rachel sachs