- Prescription drug costs - Con 2: Regulation of prices is not the solution to high drug pricesāmore responsible and affordable health insurance is the answer.
- Prescription drug costs - Pro 2: The government should regulate companies with private interests that result in price gouging, higher drug prices, and limited access to much-needed medicine.
- Prescription drug costs - Presidential actions and legislation
How can health insurance rebates affect patientsā out-of-pocket drug costs?
Health insurance rebates often fail to lower out-of-pocket costs for patients because many insurance plans do not pass these negotiated savings on to the consumer. While drug manufacturers provide rebates to health insurance companies and pharmacy benefit managers (PBMs), these financial arrangements are frequently kept confidential, and the savings are often retained by the intermediaries rather than applied to reduce the price a patient pays at the pharmacy counter.12
In some cases, the rebate system can even lead to higher costs for patients. For example, some PBMs have been accused of using a "perverse drug rebate system" that prioritizes the inclusion of high-priced drugs over lower-priced alternatives to maximize the rebates they collect. Consequently, even when net manufacturer prices decrease, patients may still face rising out-of-pocket expenses.21
To address these issues, recent legislative efforts have sought to improve transparency by mandating that PBMs pass all rebates, fees, and discounts directly to health plans and by shifting PBM compensation to flat fees to discourage the promotion of more expensive medications. Ensuring that these savings reach the patient is a matter of fundamental fairness, as shifting costs to the sick to lower premiums for the healthy undermines the ethical purpose of health insurance.31