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The Impact of Sharing Drug Rebates at the Point of Sale on Out-of-Pocket Payments for Enrollees in Employer-Sponsored Insurance

  • Yao Ding
    Correspondence
    Correspondence: Yao Ding, PhD, Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD 20857, USA.
    Affiliations
    Division of Research and Modeling, Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD, USA
    Search for articles by this author
  • G. Edward Miller
    Affiliations
    Division of Research and Modeling, Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD, USA
    Search for articles by this author
Published:September 13, 2022DOI:https://doi.org/10.1016/j.jval.2022.08.001

      Highlights

      • We found that 10.6% to 12.2% of employer-sponsored insurance enrollees in our sample would have realized savings on out-of-pocket spending if manufacturer drug rebates were shared at the point of sale. Among those with savings, approximately half would save $50 or less, and 10% would save > $500 annually.
      • Our findings suggest that a premium increase of < $1.50 per member per month among the continuously enrolled population with employer-sponsored insurance would be sufficient to finance the reduction in out-of-pocket drug spending if rebates were shared at the point of sale.

      Abstract

      Objectives

      This study aimed to estimate the impact of sharing drug rebates at the point of sale on out-of-pocket spending by linking estimated rebates to administrative claims data for employer-sponsored insurance enrollees in 2018.

      Methods

      We applied the drug rebate rate to the retail price of each brand name drug fill, allocated the reductions to out-of-pocket spending based on cost-sharing provisions, and aggregated each individual’s out-of-pocket spending across drug fills. We assumed that generic drugs have no rebates for employer-sponsored insurance. We assessed the impact of sharing rebates at the point of sale on out-of-pocket spending overall, for the therapeutic classes and specific drugs with the highest average out-of-pocket spending per user, and by health plan type.

      Results

      Across 4 simulations with different assumptions about the degree of cross-fill effects, we found that 10.4% to 12.2% of enrollees in our sample would have realized savings on out-of-pocket spending if rebates were shared to the point of sale. Among those with savings, approximately half would save $50 or less, and 10% would save > $500 annually. We calculated that a premium increase of $1.06 to $1.41 per member per month among the continuously enrolled, insured population would be sufficient to finance the out-of-pocket savings in our sample.

      Conclusions

      Our study suggests that, for a small percentage of enrollees, sharing drug rebates at the point of sale would likely improve the affordability of high-priced brand name drugs, especially drugs that face significant competition.

      Keywords

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