In 2 years, insurers must disclose what they pay for prescription drugs

Health insurers will have to disclose customers' estimated out-of-pocket costs for prescription drugs as well as the negotiated prices they pay for drugs under a new rule passed by the Trump administration, Kaiser Health News reported. 

The rule, which doesn't apply to Medicare or Medicaid and won't begin until 2022, is intended to promote competition and allow consumers to make better medical decisions. 

Advocates of the rule say it will help patients in private health plans and their physicians choose cheaper drugs, according to Kaiser Health News, but groups representing drugmakers, pharmacy benefit managers and insurers have said it will damage market competition and raise drug prices. 

Under the rule, private insurance plans will have to publish the prices they negotiated with drugmakers and pharmacy benefit managers online. They won't be required to disclose the rebates and other discounts they negotiate, Kaiser Health News reported. 

Starting in 2024, insurance plan members can request and receive estimates of their out-of-pocket expenses for prescription drugs, which would take into account their deductibles, coinsurance and copays. 

Some experts told Kaiser Health News the rule won't do much to make medications more affordable. They argue rebate discounts would disappear once all players demanded the same deal.

"Insurers and pharmacy benefit managers currently use rebates that are hidden from view to drive prices lower. If you make that transparent, you kind of reduce the main strategy payers have to lower drug prices," Aaron Kesselheim, MD, a professor of medicine at Harvard University, told Kaiser Health News

But advocates of the rule argue that if the public knows more about how much insurers pay for drugs, that could increase pressure on the government to address high prices and gaps in insurers' drug coverage, Kaiser Health News reported. 

"If the information is presented to consumers so they realize they are paying a higher price without the benefit of the rebates, you’ll get a lot of angry consumers," Niall Brennan, CEO of the Health Care Cost Institute, a nonprofit group that publishes cost data, told Kaiser Health News

The Biden administration is expected to keep the rule in place, Kaiser Health News reported. 

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