Share the Savings will improve the lives of Washingtonians who may struggle to cover out-of-pocket costs for medications and treatments by requiring health insurance companies and pharmacy benefit managers (PBMs) to share their negotiated savings directly with patients.
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Share the Savings
Health care is, unfortunately, a complicated system in the United States, with numerous players involved at every step. While the manufacturer makes the drug, the PBM contracts with the health insurance carriers to manage their prescription drug programs. PBMs are essentially the middlemen who negotiate rebates for the cost of prescription drugs and place medications within each health plan’s drug formulary. On average, manufacturers rebate 40% of a medication’s list price back to insurers or PBMs.
However, these rebates are really intended to be passed on to patients, which is particularly necessary for patients with health plans that utilize high deductibles or significant cost sharing. These patients are charged the full list price at the pharmacy counter, not the after-rebate price. PBMs and insurers pocket the savings from these rebates, while patients rarely see their fair share.
Share the Savings would fix that loophole by requiring 100% of rebates to be shared directly with patients – meaning patients see immediate savings at the pharmacy counter. Access to these rebates will help ensure patient adherence to their prescribed medications, as patients will often ration or stop medications if the over-the-counter costs are prohibitive. Share the Savings is one step that can help prevent patients from having to make that choice.
Drug manufacturers, health insurance companies and PBMs all play a part in delivering necessary medications to patients. The legislature has done much over the past few years to address the manufacturer’s role in drug pricing. Share the Savings ensures that we address other parts of the prescription drug supply chain that currently prevent savings from reaching the patients most in need of these rebates.
The WRA aim to expand access to healthcare and most importantly, improve the lives of the patients we treat. Share the Savings is one way to ensure Washingtonians can afford the lifesaving medications they need. We look forward to continuing this work to help all Washingtonians access innovative, affordable medicines.
Please don’t hesitate to reach out to learn more ways to engage on this effort!