Pharmacy Rebates for Members of Saver Plans

Increasing cost transparency and savings for our members

In an effort to lower members’ out-of-pocket costs, prevent barriers to care and improve medication adherence, Tufts Health Plan is pleased to begin passing on pharmacy rebates directly to commercial fully insured members on high-deductible Saver plan options beginning January 1, 2019. The rebates will be given at the time that the member fills their prescription at more than 68,000 participating pharmacies.

This represents another step forward in increasing cost transparency and savings for our members. When they are exposed to the cost of high cost drugs, it can be quite surprising for them. While we can’t control the prices manufacturers charge, by implementing point-of-sale rebates, we can help reduce the cost impact so our members can access the medications they need. -Marc Backon, president of Commercial Products

Prescription drug costs continuously represent a large portion of our nation’s overall health care spending. According to a Milliman research report, in 2017, pharmacy spending accounted for 17 percent of total medical spend.

Drug manufacturers pay rebates to pharmacy benefit managers, who then pass the rebates on to health plans. The rebate amount for a drug can vary widely depending on what type it is. Historically, Tufts Health Plan has used pharmacy rebates to reduce the premiums or administrative fees charged to employers, which, in turn, were passed along to employees in lower premium contributions.

“New brand-name drugs and therapies are emerging faster than ever at unimaginable prices, creating more of a burden for our members who need them, which may lead to untreated conditions, and higher medical costs down the road,” said Miriam Sullivan, vice president of pharmacy and clinical operations. “Our goal is to help keep our members healthy and to remove any barriers they encounter when seeking treatment. We know this new program will help us with that goal.”