Top Three Things You’ll Learn
- Top questions employers are asking about prescription drug rebates
- Whether drug rebates are going away or staying
- What changes employers will see under the recent drug rebate ruling
A hot topic in the news is prescription drug rebates. For people who like puzzles and tricky math like me, drug rebates can be a fun topic. For most people though, drug rebates continue to be a complex topic to navigate. For one, it can be complicated to understand how rebate arrangements work. Now, with the drug rebate ruling that emerged in 2020, many employers are even more confused on what it means for their pharmacy benefits plan.
Are Drug Rebates Going Away?
As of now, drug rebates are going to stay. Because prescription drug rebates are negotiated between pharmacy benefits managers (PBMs) and drug manufacturers, rebates are one way that drug companies compete to get their drugs on the PBM’s formulary. Without that type of leverage to force their hand, I’m not confident that the drug manufacturer’s lowest net cost will be their best price if rebates were to go away.
What’s Changing Under the Drug Rebate Ruling?
One of the main pieces of the 2020 drug rebates ruling was applying the drug rebate amount to the point-of-service member. This type of arrangement would be most helpful to members who have to pay out-of-pocket for a brand-name drug or in a co-insurance situation where the patient’s cost is tied closely to the brand drug’s list price. The ruling is planned for launch in 2022, but time will tell whether or not that changes under the new administration.
Check out the What’s Hot, What’s Not for 2021 Webinar for more information about the latest prescription drug insights and the impact on self-funded employers.