Magazine article Drug Topics

Rebates, Market Share, Co-Pays: A Changing Relationship

Magazine article Drug Topics

Rebates, Market Share, Co-Pays: A Changing Relationship

Article excerpt

The tens of thousands of dollars in rebates pharmaceutical companies are now paying to managed care organizations don't make much sense. That's the contention of Gordon Carey, a consultant with McKinsey & Co.

How so? Carey explained that rebate levels are now tied to formulary access and the market share that MCOs can garner for drug companies' products. The higher the volume MCOs can generate for manufacturers, the greater the rebate they can expect to receive. The trouble with this strategy is, while it worked in the past, it doesn't fit well anymore now that many health plans are giving consumers fewer restrictions, a choice of drugs, and open formularies.

Indeed, many health plans are offering consumers drug choice as long as they share part of the cost in the form of three-tier co-pays. Some MCOs, such as Express Scripts and Humana, are even offering four- or five-tier co-pay systems.

With their ability to move drugs into different co-pay levels, MCOs have considerable room to negotiate with drug companies. An interesting consequence is that health plans that have hitherto exerted minimal control over their drug benefit can now negotiate with drugmakers over their copay status with as much power as their counterparts that have maintained strong control, such as staffmodel health maintenance organizations. …

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