1. Amount of Rebates per Claim, 2003
Rizzo, Fox, Trail, and Crystal, State Pharmacy Assistance Programs: A Chartbook—Updated and Revised, January 2007
Amount of Rebates per Claim, 2003
On average, for the 11 states for which rebate and claims data were available, SPAPs recovered $9.11 per filed claim through manufacturer rebates. This ranged from $0.11 in North Carolina to $15.34 in Connecticut.
The amount of rebates per claim is affected by the manufacturer rebate rate, the drug mix used by enrollees (brand-name drugs usually have higher rebate rates), and the number of days’ supply per claim allowed by a program.
Massachusetts and North Carolina received the lowest amounts of rebates per claim. Massachusetts had their PBM negotiate rebates with manufacturers rather than setting the rebate amount in statute as most other states have done. This indicates that rebates that will be negotiated by PDPs will be less than those set in statutes or tied to Medicaid.
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