Great article! Changes are coming, but I don’t see the end of all rebates with PBM’s.
Gene Baker
5y
Interesting... wonder how all this will play out
CVS and OptumRx’s point of sale pricing option on its face is much better than the reinvested model of yesteryear. As long as the PBM doesn’t sandbag clients’ rebate projections, withhold the opportunity for over-performance, and charge an egregious amount for administration, it should prove to be a more plan/plan enrollee friendly model.
Timely updates by ESI and CVS and think you’re correct in pointing out the "whys" in this new transparent approach by these two: for The Street. I wish I had a gif with a person sitting back and eating popcorn to insert here. Let the finger pointing start in earnest.
Hans Airee
5y
Great article Adam. Important to understand the gross to net bubble and how it impacts the actual consumer with regards to choice and cost. Agree with you that “ it’s time for employers and health plans to be much more transparent about what they do with the tens of billions collected from manufacturers. Otherwise, as I suggested in March, they should pass through these rebates to patients at the point of sale.”
David Dross
5y
It’s no surprise that employers are using the funds for budget purposes. We suggested in our comment letter to the Trump administration’s Drug pricing RFI that moving to a post-rebate world occur over 3+ years to allow an orderly budgetary transition. Are PBMs including MAF fees as part of their rebate definition? A review of most PBM contracts would suggest no. So if they are getting a fee for rebate administration and rebates go away I think it means that revenue goes away. So PBMs may still be affected by this change.
Adam Again you’re always providing timely updates. I must post this link to what a PBM is and what a plan sponsor is. As I think this supposed opening up the books and pointing at plan sponsors as the culprit is interesting. Should be some good employee PBM meetings around the corner. Saying what % is profit doesn’t in my opinion show how the PBM still doesn’t affect a great deal of the financial float. So then is CVS and ESI saying they will just be adjudicators and manufacturers should now negotiate drug plans direct with employers? I hope we see more balance sheets in the coming months. https://www.truveris.com/resources/what-is-a-pbm-and-how-does-a-pbm-impact-the-pharmacy-benefits-ecosystem
Executive Director, Market Access | Leadership in Market Access Strategy and Operations
5yGlad to learn more about the transparency however to learn the rebate savings goes to employer bottom line on the backs of their employees medical needs is unfortunate.