Association of Branded Prescription Drug Rebate Size and Patient Out-of-Pocket Costs in a Nationally Representative Sample, 2007-2018

Abstract

This cross-sectional study investigates the association of branded prescription drug rebate size and patient out-of-pocket costs.

The influence of Medicare Part D on the list pricing of brand drugs

“…Pricing data are matched to MEPS observations via National Drug Codes (NDCs) and year, as in Yeung et al 8 As expected, the fraction of prescriptions matched in the MEPS data closely follows the fraction of all prescriptions for brand drugs each year (not shown).…”

Trends of Prescription Drug Manufacturer Rebates in Commercial Health Insurance Plans, 2015-2019

“… 1 , 2 Drug rebates can incentivize drug manufacturers to inflate list prices and PBMs to distort drug formularies to favor high list price and high rebate therapies. 1 , 2 , 3 These issues are the focus of recent policy proposals by the US Department of Health and Human Services, as well as federal legislative initiatives. 4…”

“…Recent studies have estimated overall price concessions for prescription drugs by using drug manufacturers’ financial disclosures. 2 , 3 , 5 However, estimated overall price concessions also include coupons, discounts, and other nonrebate items that do not necessarily affect PBMs’ incentives, and it remains unknown what insurance plan characteristics are associated with drug rebates. In this economic evaluation, we examined the magnitude and trend of prescription drug rebates in commercial markets from 2015 to 2019 and identified insurance plan factors associated with rebates.…”

Oncology Drug Prescribing: The Influences of Greed and Fear

“…In addition, payers generally receive confidential rebates from pharmaceutical manufacturers and thus may also be similarly motivated to encourage prescribing of expensive oncology drugs (eg, if they are processing claims on behalf of a self-insured corporation who is the ultimate payer). 5 Meanwhile, fear of recurrence and death is common among patients with cancer, and high levels of anxiety and worry can interfere with appropriate decision making. Thus, a financially motivated physician interacting with a scared patient often leads to administration of an expensive drug, particularly since a discussion about less toxic or less expensive treatment options (or a watch and wait approach) is timeconsuming, yields no revenue related to prescribing, and scores no key opinion leader prescribing points.…”

“…In addition, payers generally receive confidential rebates from pharmaceutical manufacturers and thus may also be similarly motivated to encourage prescribing of expensive oncology drugs (eg, if they are processing claims on behalf of a self-insured corporation who is the ultimate payer). 5…”