Point of Sale Rebate Analysis in the Commercial Market

Sharing rebates may lower patient costs and likely has minimal impact on premiums

Point of Sale Rebate Analysis

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Pharmaceutical manufacturers often pay significant rebates to pharmacy benefit managers (PBMs) or payers (including plan sponsors and health plans) on brand medications for favorable formulary placement and other demand incentives. Traditionally, payers do not share these rebates directly with members. Instead, rebates reduce a payer’s pharmacy liability, which they often use to lower premium rates across all members. Under this approach, all members benefit from reduced premium, and members using brand medications pay the same out-of-pocket (OOP) costs regardless of whether or not a payer received a rebate.

Point of Sale Rebate Analysis