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

Feb 1, 2023, 00:00
10.1016/j.jval.2022.08.001
https://www.valueinhealthjournal.com/article/S1098-3015(22)02141-6/fulltext
Title : The Impact of Sharing Drug Rebates at the Point of Sale on Out-of-Pocket Payments for Enrollees in Employer-Sponsored Insurance
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(22)02141-6&doi=10.1016/j.jval.2022.08.001
First page : 226
Section Title : HEALTH POLICY ANALYSIS
Open access? : No
Section Order : 226

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.

Categories :
  • Cost/Cost of Illness/Resource Use Studies
  • Economic Evaluation
  • Generics
  • Health Policy & Regulatory
  • Reimbursement & Access Policy
  • Specialized Treatment Areas
Tags :
  • drug rebates
  • employer-sponsored insurance
  • out-of-pocket savings
  • patient affordability
  • premium
Regions :
  • North America
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