Group Plan >> Rebate

ECT’s systematic evaluation for processing claims includes an evaluation of current rebate handling and any changes in the future.

Manufacture’s rebates provide a significant means to offset prescription drug costs for the plan and for its members.   Rebates fall into two categories: manufacturer discounts to the PBM’s and discounts to Medicare members during Gap.

  • Issues with rebates to PBM’s which directly impact plan costs
  • Formulary status of drugs change frequently and therefore tracking rebate revenue can be problematic
  • Rebates are also impacted by preferred vs. non-preferred status, rank in co-pay tier, and market share within the respective therapeutic categories covered.
  • Starting in 2014, CMS is instituting reporting to increase rebate payments based on the concern that all rebates have not been collected and used to offset plan costs 
  • Impacts of manufacturer’s discounts in the Medicare Gap phase for the member
  • CMS is supporting manufacturers in correct handling of gap claims.  This can increase costs to both the member and the plan if not handled per guidance.  ECT’s goal is to work with plans to ensure claim processing meets the current guidelines and provides maximum rebates to offset drug costs at a time the members are most vulnerable.