The U.S. Department of Health and Human Services has recently set out guidelines that require health insurance companies to reveal the prices of drugs and other cost-sharing information.
Pharmacists praised the new rule. An American Pharmacists Association spokesman said they are hopeful that the new regulations will finally bring some much-needed transparency to how pharmacy benefits managers price drugs. PBMs have been enriching themselves at the expense of pharmacists and patients and impairing the relationship pharmacists have with their patients, according to the APhA.
What It Does
The new rule enables about 200 million Americans with private insurance to see current price information and cost-sharing data to know how much the medication will cost before they go for treatment. There is a shopping tool available to consumers through their health plans that enables them to see the price that has been negotiated between their physician and their health plan or insurer. They can also get the most accurate estimate for their out-of-pocket costs for medical procedures, drugs, and durable medical equipment.
Health plans must make public in-network prices for prescription drugs, factoring in any rebates or concessions made after the drugs are sold. They also need to show a drug’s historical net price. But the pricing information will not include the amount of any rebate itself.
Also, the negotiated rate might be different for brand name and generic drugs. Prices may also be different depending on the insurance plan or carrier. The guidelines only mandate that two specific pieces of information be made public – what patients have to pay out-of-pocket and the cost that has been negotiated by the health insurer.
The new guidelines will empower patients, according to healthcare officials. Because patients will be able to find out what medication costs are before going for care, people will be able to shop around for the best prices.
A big problem with healthcare in the United States, according to healthcare experts, is that these markets are not competitive, adding that these new guidelines, by providing more information, will make the healthcare markets more competitive.
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