Pharma and Trump administration officials decry them as backroom deals. But payers and PBMs say rebates are an important negotiating tool with drugmakers. Take it away and drug expenditure will go up even faster.
With accumulators, the value of any copay assistance cards or coupons does not count toward out-of-pocket medicine costs that are applied toward deductibles. It’s a cost-shifting tool that’s facing pushback from patients, providers, and others saying that accumulators will hurt public health.
It is finally starting to happen. The first gene therapy to treat an inherited disease is out of the gate. But my, that price tag: $850,000. Many more gene therapies are on their way. How can they be priced to hit the sweet spot of affordability, access, and innovation? Outcomes-based pricing doesn’t really do the trick.
Despite standardization, advocates for various industries and certain patient needs continue to propose changes in coverage rules. Much of the advocacy is occurring at the state level with a focus on pharmaceutical coverage, such as equalizing cost sharing between oral and infused oncology drugs or setting limits on cost sharing for prescriptions.