How Drug Money From Sick People Really Works

Rebates are commissions.

So Joe Sixpak goes to the pharmacy to fill his diabetes prescription drug. Between Joe and his insurance plan the pharmacy is paid $408. The pharmacy keeps $69. Where does the rest of it go?

In 2019, Sanofi offered OptumRx rebates up to 79.75% for Lantus for preferred formulary placement on their client’s commercial formulary.” Sanofi is the manufacturer of Lantus.

What would happen if rebates were simply point-of-sale price concessions. Rather than constantly moving money between parties, the net drug price is $69 above (i.e., $408 Lantus cost at the pharmacy minus the $339 rebate).

Prescription drug price markups make the Columbian drug cartel blush. They are on the wrong side of the business.

Joe Sixpak expends $1,906.72 annually per year on Lantus. The health plan’s total net expenses are $1.078.72. The health plan makes around a thousand dollars off Joe’s drug habit.

Joe has no clue but that’s okay because “insurance is paying for most of this.” is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods