Federal agencies that regulate drug pricing and healthcare insurance that an industry practice of using rebates to lower drug costs for insurers has led to increases in list prices and out-of-pockets costs for patients.
To investigate whether patients with or without insurance were paying more because of rebates to insurers, researchers led by the 天美影视传媒 examined cost and price data on more than 400 branded drugs. The found that rebates were associated with increases in out-of-pocket costs for patients by an average of $6 for those with commercial insurance, $13 for Medicare patients and $39 for the uninsured.
鈥淲e know that list prices have been increasing quite dramatically as have rebates, but no one has looked into the association between rebates and out-of-pocket costs,鈥� said study lead author , an affiliate assistant professor at the in the UW School of Pharmacy. 鈥淚ncreases in out-of-pocket costs are associated with rebates, however rebates also help keep premium costs down.鈥�
Consequently, said Yeung, who is also an assistant professor at Kaiser Permanente Bernard J. Tyson School of Medicine, 鈥淭here has been inadequate focus on the impact the pricing mechanism has on the uninsured, who are most affected.鈥�
For the , the researchers used data on 444 branded drugs without generic equivalents from national datasets involving healthcare costs and drug prices from 2007 to 2018 including the federal and , a private company that collects and analyzes prescription drug pricing data.
Researchers point out that the cost increases can impact patient health, since higher costs can cause patients to take their medication less often. That, in turn, can lead to increased emergency room use and hospitalizations. People in their study who did not have insurance had the poorest health and those with lower incomes were less likely to take medication as prescribed when costs increased.
鈥淔urther,鈥� the researchers wrote, 鈥渦ninsured individuals were more likely to be in racial minority groups, amplifying pre-existing disparities in healthcare access.鈥�
As a result, the authors suggest future research and policies should focus on decoupling list prices from what patients pay out of pocket, 鈥渆specially for uninsured individuals.鈥�
鈥淭he biggest takeaway is understanding that the rebates work to reduce the cost of prescription drugs for insurance companies and may reduce premiums,鈥� said co-author , the Stergachis Family endowed director of the CHOICE Institute and professor of health economics at the UW School of Pharmacy. 鈥淎nd while it鈥檚 unclear how much the discounts are reducing premiums, they are definitely not translating to lower out-of-pocket costs for the patients who are using the treatment because of this structure of coinsurance and copayments tied to the list price.鈥�
Stacie Dusetzina, Vanderbilt University School of Medicine, Nashville, Tenn., is also a co-author. This research wassupported in part by grant funding from the Donaghue Foundation鈥檚 Greater Value Portfolio.
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For more information, contact Yeung at Kai.Yeung@kp.org and Basu at basua@uw.edu.