Life Science Compliance Update

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March 16, 2018

UnitedHealthcare Will Share Rebates with Patients


On March 6, 2018, UnitedHealthcare announced that beginning in 2019, the company will expand its pharmacy discounts to the seven million enrollees who are in fully insured commercial group plans at the point of sale for drugs, if a rebate is offered by the manufacturer.

The savings will apply to plan participants who are filling a prescription for a drug where the manufacturer provides a rebate. The savings from the rebates will be applied upfront, at the time of the sale, to ensure that patients are paying the lowest amount possible under their insurance plan. UHC notes that currently, rebates are used to keep premiums lower for the benefit of all insurance-holders, rather than be distributed to benefit individual consumers.

According to the press release, plan participants will be able to log into their online account through UnitedHealthcare to see what the discounted cost of their drug will be, which will show savings from the rebate. Not all drugs come with rebates that are paid to the health plan and it is likely that patients with high deductibles who buy drugs that carry large rebates will see the largest savings. Further, the amount of rebates can vary widely, with some drugs, like Humira and Enbrel that treat rheumatoid arthritis, being deeply discounted. Others, like medicines for rare conditions where there is no significant competition, have little to no rebates. 

“UnitedHealthcare is uniquely positioned to deliver new value and clarity to health care, and pharmacy benefits in particular,” said Dan Schumacher, president and chief operating officer, UnitedHealthcare. “Our differentiated pharmacy model, powered by OptumRx, is delivering solutions that lead to better health outcomes and make prescription drugs more affordable.”

“People use their pharmacy benefit more frequently than any other type of benefit, which means pharmacy provides the greatest opportunity for us to understand and meet their needs,” said Schumacher. “We believe our efforts to enhance value for our customers will not only benefit our members, but the health care system as a whole.”

This new plan by UHC addresses a central element of the United States Department of Health and Human Services (HHS) plan to lower prescription drug prices – an element that calls for insurers to directly share rebates with members.

HHS Secretary Alex Azar issued a statement in response to UnitedHealthcare’s announcement that they would begin to share manufacturer rebates and discounts with patients at the pharmacy. In his statement, he said,

“Today’s announcement by UnitedHealthcare is a prime example of the type of movement toward transparency and lower drug prices for millions of patients that the Trump Administration is championing. Empowering patients and providers with the information and control to put them in the driver’s seat is a key part of our strategy at the Department of Health and Human Services to bring down the price of drugs and make healthcare more affordable. We are already seeing clear momentum toward the type of innovation in the private-sector that will be an important part of the value-based transformation that is coming to America’s healthcare system.”

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