“Payers are going to have to decide what they want,” Dr. Gottlieb said at the conference sponsored by America’s Health Insurance Plans. “Do they want the short-term profit boost that comes with these rebates or in the long-run assist in their function” to make things better for patients, for providers, and those who pay for care.
criticized the insurance industry for profiting from rebate-based contracts and creating an environment where there is a significant disincentive for biosimilars to come to market. He decried the “rebate trap” in which insurers profit from the difference between the wholesale acquisition cost and the actual rebated price. Because manufacturers typically tie rebates to volume, there is no incentive for plans to incorporate biosimilars, which could cost insurers some or all rebates from the reference biologic product, Dr Gottlieb noted.
It is possible to spur competition while working within the confines of the rebate-based system, he said. “I don’t see these as binary choices. You can have your cake and eat it too. Or in this case your rebates.”