Drug Rebate Aggregators-Playing a Pivotal Role in Drug Pricing
Pharmacy benefits managers (PBMs) negotiate rebates on behalf of clients, including insurers and employers. PBMs use formularies to rank drugs in tiers that determine how much patients end up paying out of pocket.
With the drug pricing controversy increasing, pharmaceutical companies lobby patients to pay as little out of pocket as possible, so they often make concessions in negotiations with PBMs to receive more favorable formulary placement for their drug.
Major PBMs often offer their own claim processing services, pharmacy network agreements, and rebate contracts. Smaller or mid-tier PBMs do not own their own claims processing engine, instead they utilize another company’s pharmacy network agreements, and become a larger rebate aggregator.
Drug Rebate Aggregators act as an aggregation point for sub-contracted entities to submit their rebate invoices or drug administration information and then combines data into consolidated rebate invoices for transmittal to manufacturers.
Senator Ron Wyden recently proposed legislation that would force drug middlemen to disclose secret discounts they receive from manufacturers, a sign of growing scrutiny of the role played by pharmacy benefit managers in high prices.
The bill, the Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act, would take several steps to improve transparency and ensure people in Medicare receive a fair share of rebate savings. It would require PBMs to disclose the aggregate amount of rebates they receive from pharmaceutical companies, and what proportion of those rebates go to Americans in Medicare.
AMI’s new report provides background on drug rebates while identifying the companies that are acting as drug rebate aggregators. The Table of Contents:
Drug Rebates – pgs. 4-11
- Government Drug Rebate Program
- DIR Fees
- Recent Activities
Company Profiles – pgs. 12-38
- Argus Health Systems
- ARMSRx Pharmacy Consulting
- Change Healthcare
- Conduent Inc.
- Gateway Health Partners
- Health Delegates
- IntegriScripts, LLC
- MedOne Healthcare Systems
- Pharmaware, LLC
- RxPreferred Benefits
- Summit Rx
- The Rodenhizer Group