Express Scripts warns rebates shrinking, pitches PMPM guarantee and rebate‑free options for 2028 RFP
Express Scripts told the board that federal policy and biosimilar competition have reduced traditional rebate payments; ESI recommended moving toward a per‑member‑per‑month (PMPM) guarantee or rebate‑free pricing and offered point‑of‑sale rebate options for members.
The full story
Express Scripts presented industry changes reshaping pharmacy rebates and pricing and walked the board through causes and options ahead of the 2028 PBM RFP. ESI's Amy Daley attributed falling rebate payments to federal actions (ARPA and the Inflation Reduction Act) and the arrival of biosimilars, which have lowered list prices and reduced behind‑the‑scenes manufacturer rebate payments. Daley said PEBB experienced a roughly 6–7% decline in rebate payments comparing FY25 to FY26, driven largely by biosimilars, but that ingredient‑cost declines from biosimilars can more than offset lost rebates.
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