The rebate rule drafted by the Department of Health and Human Services last year has not gone down too well with insurers and PBMs. America’s Health Insurance Plans (AHIP) is keeping fingers crossed and waiting for the Biden administration to pull the rule, which many see as a gift to the pharmaceutical industry. The rule, according to insurers, may result in higher premiums for Part D beneficiaries. The rule has been challenged in the court of law by the Pharmaceutical Care Management Association, which represents PBMs.
- AHIP is in contact with the Biden administration about the likely effects of the rule, according to its CEO Matt Eyles. “We’re hopeful that the rule will not be put into effect… There’s so much uncertainty around that. We have been communicating some of those challenges to the new administration,” he said.
- The rule will not allow pharmacy benefit managers to enjoy anti-kickback safe harbors for drug rebates in Part D. They will be left to offer discounts at the point of sale.
- Price transparency regulations enacted this month are another challenge before insurers. The new regulations call for hospitals to put their payer-negotiated payment rates for services online. This could be a precursor to a similar regulation for insurers wherein they would be required to post online the negotiated rates and cost-sharing data. This is likely to be enacted in 2023 for 500 shoppable services.
- According to Eyles, the rule does not give data to customers in an actionable manner and will serve to undercut competition and negotiation on pricing. Eyles feels that the providers who know their competition and their bid may not bid aggressively.
- Eyles said that in their bid to make data about costs more personalized, insurers offer cost estimators to members. “That’s why health insurance providers are constantly developing resources to help people understand what their costs will be,” he said.