As drug rebates continue to grow more complex, many health organizations are getting stuck in the red tape of rebate “partners.” Others give up and simply trust that they were able to secure a benevolent or altruistic rebate partner.
Unfortunately, with many rebate aggregators favoring opaque manufacturer rebate arrangements, altruism and money are down the drain. But, there are a few things you can keep in mind that may help navigate these murky waters and keep you from leaving money on the table.
Know the pros and cons of a pass-through model v. a guaranteed model
This is the first step in arming yourself against potentially money-losing rebate arrangements and contracts. For example, a pass-through model may seem ideal, but do you really know what (or who) is driving those rebate aggregators? And, in comparison, a guaranteed or fixed model may seem dependable, but do you know if you are getting capped on your rebates? Clarification on key points can save you a lot of money.
This is a great second step. Staying educated on the gray areas of contract terms and language, where unfair financial advantages may be lurking under the radar, can help you avoid making assumptions about what your rebates might be, which can put lowering your overall drug spend in jeopardy.
Remember – the answer to a lower drug spend may be neither model
It’s true. Sometimes, the best way to lower a drug spend might be to simply forgo a rebate all together. Things like when there’s a:
- Generic equivalent is available
- Clinically the rebated drug does not have the same efficacy or if the
- Cost of a non-rebated drug is less
Look for a rebate aggregator who will accept the challenge of rethinking the link between data and dollars and provide their customers with more actionable insights and control over the net drug costs. Getting access to a formulary that optimizes rates, rebates, copays, and discounts – and shows you exactly where your rebates are earned, right down to the claim and NDC level, is just one level of transparency that will provide the insights needed to turn action into dollars.
Chasing rebates can be a nightmare of formulary audits and, even after expending all that energy, there is still no guarantee that you are going to get the best price – with or without a rebate – in order to see that net drug spend decrease.
So, remember, as the saying goes, “If it sounds too good to be true, it probably is.”
You deserve to know exactly what you are getting. Whether you are a health plan, a PBM, or an employer group, you need a partner who can see through opaque contracts -- before you can sign them – and provide you the transparency and clarity necessary to get you the lowest costs possible.