Measuring the impact of Point of Sale rebates on the commercial health insurance market

There has been heightened interest in understanding the dynamics, challenges, and impacts of passing pharmacy rebates directly to members at the point of sale (POS). We explored how applying rebates in this manner would affect both member premiums and cost sharing for an average member as well as hypothetical patients with selected chronic conditions. In this analysis, we modeled the impact of applying all manufacturer rebates at the POS and observed the resulting reallocation of payer and member costs among various plan designs typically found in the employer market. We project that doing so lead to minimal plan cost increases of 0.6% or less for payers, and that the largest reductions in out-of-pocket costs are for members enrolled in coinsurance plans.

This report was commissioned by PhRMA.