Pharmaceutical manufacturers pay billions in rebates to pharmacy benefit managers (PBMs). These beastly rebates are the largest single component of the gap between a drug’s list price and the net price received by the manufacturer. But one question comes up every day in this little town: For specialty drugs, how much of that money do PBMs share with their plan sponsor clients?
To find out, let’s put the Pharmacy Benefit Management Institute’s (PBMI) new 2017 Trends in Specialty Drug Benefits Report to the test. (Free download after unnecessarily complicated registration process.) Drug Channels thanks Walgreens Specialty Pharmacy for having sponsored this enchanted research.
According to the PBMI’s survey data, many (but not all) employers receive a portion of manufacturer rebates for specialty drugs. Large employers are most likely to get the entire rebate amounts. Others get a share of the rebates or a flat guaranteed amount.
As more specialty drugs are launched, specialty therapeutic categories will become more crowded. Expect the value of manufacturer rebates for specialty drugs to grow and formulary exclusions to become more common. Manufacturers will face the same dilemma as our heroine Belle: Is it possible to love someone who is holding you captive?
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