Rebates Under Part D:Comments From Administrators

Rebates Under Part D:
Comments From Administrators

Excerpted from Oct. 16 survey conducted by Milliman on behalf of the Academy of Managed Care Pharmacy. Responses are from unidentified senior staff members of five Medicare Part D plan administrators of varying size who serve, in total, more than 11 million beneficiaries. The proportion of low-income subsidy members among the 11 million ranged from 16 percent to 68 percent.

Description of how Medicare policy for the six protected classes affects use of managed care tools.

"We lack the ability to negotiate as there are limited controls that we as a plan can put in place that allow us to negotiate better pricing from the manufacturer. In a lot of cases these manufacturers do not even have a contact person calling on our organization."

"Limits our ability to effectively manage net cost of category and limits negotiation leverage."

"The protected classes allow pharmaceutical manufacturers to not offer significant rebates because they knew that their products had to be represented on formulary. The protected classes also did not really allow for step edits or prior authorization since we had to ensure that members were not turned away at the pharmacy."

Explain concern that additional drug classes will be added to protected list.

"If more classes are protected like this, it will limit the ability of the plan to put pressure on the manufacturer to increase its discount or offer a discount altogether...There are a number of branded manufacturers in the protected classes who do not even call on our account. One company in particular finally gave us the opportunity to present to senior executives after 18 months of just trying to get the company to call us back. After our meeting they informed us that it is not in their business plan to rebate in the HIV space."

"New legislative mandate opens the door for additional lobbying for more classes to be added."