UnitedHealthcare broadens direct drug rebate program

14 Mars, 2019, 16:07 | Auteur: Yves Courtet
  • UnitedHealthcare appears to be the first major insurer to require new employer clients to apply rebates to consumers’ out-of-pocket expenses

UnitedHealth and OptumRx will significantly expand a program that will require new employer clients to pass rebates to the consumers who take their medications. However, the program will only encompass employer-sponsored plans that directly contract with OptumRx to administer pharmacy benefits.

Drugmakers pay rebates to insurers and PBMs to lower the list price of prescription drugs in exchange for being included on their formularies, a list of approved drugs.

"Patients are seeing concrete benefits from UnitedHealthcare's groundbreaking point-of-sale discount program, which is just one element in our commitment to help deliver better health, lower costs and a better experience", said Daniel J. Schumacher, president and chief operating officer of UnitedHealthcare.

Existing OptumRx and UnitedHealthcare clients will have the option to adopt these plan designs during contract renewal.

Rebates have come under harsh criticism and are blamed for helping to push up the list price of drugs, which consumers are increasingly responsible for paying.

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As consumer anger over drug prices has grown, pharmaceutical companies and insurers have increasingly pointed fingers at each other, with drug companies accusing insurers of profiting from their share of the rebates they collect, while insurers say the manufacturers are the ones who decide what a drug costs.

In fact, both price actions come amid growing pressure from Congress to rein in soaring drug prices.

In January, the Trump administration proposed a similar move for government health-care programs like Medicare.

UnitedHealthcare said about a year ago that rebates would start shifting directly to the customer filling prescriptions for people covered by employer-sponsored health coverage that is fully insured. But those discounts rarely flow directly to the people filling prescriptions.

Instead, they are often passed on to companies that sponsor employee insurance plans and are used to reduce premiums or offset other plan costs. "But it will also put money back in consumers' pockets", he said.

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