Reference Based Rx Pricing

Many plans are adopting Reference Based Pricing for their medical coverage. They can do the same for their Rx coverage.

Here is how it works: Drugs are grouped into classes in which all drugs have identical or similar therapeutic effects.

For example, all brands of ibuprofen would be in the same class because they contain the same active ingredient. The class could include other non-inflammatory agents like aspirin and naxproxim because they are therapeutically similar.

The insurer pays only one amount called the reference price for any drug in each class. The plan member pays a co-pay plus any amount over the reference price.


Comments are closed.