- •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.
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- Financing and distribution of pharmaceuticals in the United States.JAMA. 2017; 318: 21-22
Atlas RF. The role of PBMs in implementing the Medicare prescription drug benefit. Health Aff (Millwood). 2004;Suppl Web Exclusives:W4-504-515.
- Association of drug rebates and competition with out-of-pocket coinsurance in Medicare Part D, 2014 to 2018.JAMA Netw Open. 2021; 4e219030
- A transparent and consistent approach to assess US outpatient drug costs for use in cost-effectiveness analyses.Value Health. 2018; 21: 677-684
- Changes in list prices, net prices, and discounts for branded drugs in the US, 2007-2018.JAMA. 2020; 323: 854-862
- Prescription drugs-list price, net price, and the rebate caught in the middle.JAMA. 2019; 321: 1563-1564
- Correlation between changes in brand-name drug prices and patient out-of-pocket costs.JAMA Netw Open. 2021; 4e218816
- Branded price variation in the United States drug market, 2010 to 2019.Value Health. 2021; 24: 1237-1240
- Sharing drug rebates with Medicare Part D patients: why and how. Health Affairs Blog.https://www.healthaffairs.org/do/10.1377/hblog20200911.841771/full/Date accessed: January 20, 2021
- The impact of prescription drug rebates on health plans and consumers. Altarum.https://altarum.org/sites/default/files/Altarum-Prescription-Drug-Rebate-Report_April-2018.pdfDate accessed: June 23, 2021
- Flow of money through the pharmaceutical distribution system. Leonard D. Shaeffer Center for health Policy and economics. White Paper.http://healthpolicy.usc.edu/documents/USC%20Schaeffer_Flow%20of%20Money_2017.pdfDate accessed: February 28, 2022
- Association of prescription drug price rebates in Medicare Part D With Patient out-of-pocket and federal spending.JAMA Intern Med. 2017; 177: 1185-1188
- How would sharing rebates at the point-of-sale affect beneficiary cost-sharing in Medicare Part D? Leonard D. Shaeffer Center for Health Policy and Economics. White Paper.https://healthpolicy.usc.edu/research/how-would-sharing-rebates-at-the-point-of-sale-affect-beneficiary-cost-sharing-in-medicare-part-d/Date accessed: January 20, 2021
- US brand price tool. SSR Health.http://www.ssrhealth.com/us-brand-rx-net-price-tool/Date accessed: August 17, 2021
- Net spending on retail specialty drugs grew rapidly, especially for private insurance and Medicare Part D.Health Aff (Millwood). 2020; 39: 1970-1976
- The use of medicines in the U.S.: spending and usage trends and outlook to 2025. IQVIA.https://www.iqvia.com/insights/the-iqvia-institute/reports/the-use-of-medicines-in-the-usDate accessed: June 8, 2021
- Table. I.F.2 and I.F.3: Average individual (family) deductible per employee enrolled with single (family) coverage in a health insurance plan that had a deductible at private-sector establishments by firm size and selected characteristics: United States. Medical Expenditure Panel Survey Insurance Component.https://meps.ahrq.gov/data_stats/summ_tables/insr/national/series_1/2019/tif2.pdfDate accessed: May 11, 2022
- Medical expenditure panel survey insurance component Table. I.F.30 Percent of private-sector employees enrolled in a health insurance plan that had a prescription drug copay for generic, preferred, non-preferred, and specialty tiers by selected characteristics: United States. Medical Expenditure Panel Survey Insurance Component.https://meps.ahrq.gov/data_stats/summ_tables/insr/national/series_1/2019/tif30.pdfDate accessed: May 11, 2022
- Table I.B.1.a Percent of number of private-sector employees by firm size and selected characteristics: United States, 2019. Medical Expenditure Panel Survey Insurance Component.https://meps.ahrq.gov/data_stats/summ_tables/insr/national/series_1/2019/tib1a.pdfDate accessed: June 8, 2021
- Prices for and spending on specialty drugs in Medicare Part D and Medicaid: an in-depth analysis, working Paper 2019-02 (Congressional Budget Office, March 2019).www.cbo.gov/publication/55011Date accessed: May 8, 2022
- Best practices using SSR health net drug pricing data. Health Affairs blog.https://www.healthaffairs.org/do/10.1377/forefront.20220308.712815Date accessed: March 23, 2022
- Specialty drug coupons lower out-of-pocket costs and may improve adherence at the risk of increasing premiums.Health Aff (Millwood). 2014; 33: 1761-1769
- Authors’ calculations from a non-public version of the 2019. Medical Expenditure Panel Survey, Pharmacy Component.https://www.meps.ahrq.gov/data_files/publications/mr29/mr29.shtml#13PharmacyComponentDate accessed: July 12, 2022
- UnitedHealthcare will provide drug rebates directly to members in some plans. The Washington Post. March 6, 2018.https://www.washingtonpost.com/news/wonk/wp/2018/03/06/unitedhealthcare-will-provide-drug-rebates-directly-to-members-in-some-plans/Date accessed: June 8, 2021
- Steady increase in prices for oral anticancer drugs after market launch suggests A lack of competitive pressure.Health Aff (Millwood). 2016; 35: 805-812
- Medicare Part D: time for re-modernization?.Health Serv Res. 2019; 54: 1174-1183
- Part D Senior savings model. Centers for Medicare & Medicaid Services.https://innovation.cms.gov/innovation-models/part-d-savings-modelDate accessed: July 12, 2022
- Trends in List Prices, Net Prices, and Discounts for Originator Biologics Facing Biosimilar CompetitionSan-Juan-Rodriguez A.JAMA Netw Open. 2019; 2e1917379
- Do copays count toward your health insurance deductible? Verywellhealth.https://www.verywellhealth.com/do-copays-count-toward-your-health-insurance-deductible-1738551Date accessed: August 17, 2021
- Association of branded prescription drug rebate size and patient out-of-pocket costs in a nationally representative sample, 2007-2018.JAMA Netw Open. 2021; 4e2113393
- Employer health benefits survey: section 8. High-Deductible Health Plans With Savings Option. Kaiser Family Foundation.https://www.kff.org/report-section/ehbs-2020-section-8-high-deductiblehealth-plans-with-savings-option/Date accessed: August 4, 2021
- Table I.F.32 Percent of private-sector employees enrolled in a health insurance plan that had a prescription drug coinsurance for generic, preferred, non-preferred, and specialty tiers by selected characteristics: United States, 2019. Medical Expenditure Panel Survey Insurance Component.https://meps.ahrq.gov/data_stats/summ_tables/insr/national/series_1/2019/tif32.pdfDate accessed: June 8, 2021
- Incorporating the effects of the proposed rule on safe harbors for pharmaceutical rebates in CBO’s budget projections—supplemental material for updated budget projections. Congressional Budget Office.www.cbo.gov/publication/55151Date accessed: August 18, 2021
- Potential impact of pharmaceutical industry rebates on medication adherence.Am J Manag Care. 2019; 25: e135-e137