Aetna to Offer Point-of-Sale Pharmacy Rebates to Three Million Customers

Company hopes added transparency will “rationalize” drug pricing

Aetna, Inc., has announced that it will automatically pass on drug-maker rebates to about three million commercial members at the point of sale beginning in 2019, according to a BioPharma Dive report.

The move comes less than a month after UnitedHealth Group, Inc., announced a similar initiative, which drew praise from Health and Human Services Secretary Alex Azar as a step towards increased health system transparency.

Aetna has opposed the Centers for Medicare and Medicaid Services (CMS) idea to mandate that Part D sponsors pass on a percentage of rebates to customers at the point of sale. In a comment to CMS, the insurer previously wrote that the idea would give “a windfall to manufacturers, higher premiums, and little relief for individual consumers.”

At the heart of the debate is a question raised by pharma companies asking what insurers and pharmacy benefit managers (PBMs) use rebates and discounts on. Insurers have argued that the rebates already reach customers through lower premiums.

Aetna argued that the “majority of rebates have always been passed on to plan sponsors and their employees through lower premiums,” according to the article.

“Going forward, we hope this additional transparency will encourage these companies to rationalize their pricing and end the practice of annual double-digit price increases,” Aetna CEO Mark Bertolini said in a statement.

Aetna is attempting to merge with CVS Health in a $69 billion deal.

Azar has pushed shifting rebates to the point of sale, and CMS issued a request for information on the proposal to mandate a percentage of rebates be passed on in Medicare Part D.

“Empowering patients and providers with the information and control to put them in the driver’s seat is a key part of our strategy at the Department of Health and Human Services to bring down the price of drugs and make health care more affordable,” Azar previously said in a statement.

Aetna told BioPharma Dive it has not altered its position in opposition to the CMS idea given adverse selection concerns, but reiterated that it supports “adding a true out-of-pocket cap for consumers” in Part D plans and eliminating so-called “gag clauses” that prohibit pharmacists from informing customers paying cash for a drug may be cheaper than utilizing health insurance.

Bertolini also targeted drug manufacturers, saying additional reforms are needed to increase transparency throughout the entire supply chain. “Payers are required to spend the vast majority of premium dollars on medical costs, not overhead or profits. Drug manufacturers should be held to the same high standards,” he said.

Source: BioPharma Dive; March 27, 2018.