Not all stakeholders are convinced that UnitedHealthcare's newly announced change of policy is enough to offset the role that pharmacy benefit managers have had in rising out-of-pocket costs for consumers.
This week, UnitedHealthcare announced that it would expand direct-to-consumer pharmacy discounts when patients fill their prescriptions through retail pharmacies or via home delivery. The discounts, the insurer says, provide patients with savings from manufacturers’ rebates negotiated by UnitedHealthcare’s pharmacy benefit manager (PBM), OptumRx.
The program will apply to more than 7 million members who are fully insured through group health benefit plans, and will take effect in January 2019. Customers will be able to log in to UnitedHealthcare’s website to view the price of their drug, including the discount from the rebate.
HHS Secretary Alex Azar praised the move, saying that the change is “a prime example of the type of movement toward transparency and lower drug prices for millions of patients that the Trump Administration is championing,” and FDA Commissioner Scott Gottlieb, MD, said that this “potentially disruptive step” could make a substantial difference for patients’ out-of-pocket costs.
However, not all stakeholders are convinced that the newly announced change of policy is enough to offset the role that PBMs have had in rising out-of-pocket costs for consumers.
The Alliance for Transparent and Affordable Prescriptions (ATAP), an organization comprising provider and patient groups, met the news of UnitedHealth’s plan with cautious optimism; a spokesperson for ATAP told The Center for Biosimilars® in an email that, “This new policy could help lower out-of-pocket costs for patients, and we are hopeful that when implemented, UnitedHealthcare’s policy will reflect the need for a more transparent, patient-centered drug delivery system in the United States.” However, said ATAP, “while this may be a step in the right direction, there is much more work to be done to bring meaningful change to the convoluted and opaque rebate system.”
Both patients and their physicians still have very little information about what drugs truly cost health plans, says ATAP, and PBMs continue to design their formularies around rebate amounts, not around patients’ costs.
But, says ATAP, UnitedHealthcare’s change of policy is a sign that the organization’s core message and advocacy are beginning to resonate with policy makers and with the general public.
UnitedHealthcare’s announcement comes at a time when PBMs have been under heavy scrutiny for their practices: state-level legislation has targeted so-called “clawbacks,” which occur when a patient’s co-pay or coinsurance is higher than the negotiated price of the drug, which allows the PBM to retain the profit. Furthermore, physicians have warned that PBMs have a growing influence over which drugs can be prescribed.
While UnitedHealthcare’s announcement could help to improve the public image of the PBM industry, it remains unclear how much patients themselves will benefit from the change; a spokesperson for another PBM, Express Scripts, told The Washington Post that it already allows clients to share rebates directly with customers, but that there has been little uptake of this plan among participants. Instead, many clients choose to apply the rebates to more broadly lower members’ premiums.