Patients share the costs for their medicines. They should share the savings, too.
Robust negotiations between biopharmaceutical companies and health plans result in significant rebates and discounts. According to a recent study from the Berkeley Research Group, more than a third of the list price for brand medicines is rebated back to payers and the supply chain.
However, unlike care received at an in-network hospital or physician’s office, negotiated discounts for medicines are not shared with patients with high deductibles or coinsurance. A new analysis from Amundsen Consulting, a division of QuintilesIMS, found more than half of commercially insured patients’ out-of-pocket spending for brand medicines is based on the full list price. The data also show cost sharing for nearly one in five brand prescriptions is based on the list price.
It is a problem that more and more Americans are being asked by their insurers to pay cost sharing based on undiscounted list prices, even though insurers may be receiving significant rebates. Providing access to discounted prices at the point-of-sale could dramatically lower patients’ out-of-pocket costs. For example, a patient in a high-deductible health plan who pays $350 each month for insulin, an amount calculated based on the list price of the medicine, may be paying hundreds—or even thousands—more annually than their insurer.
Get the facts and find out where the discounts are going.