Chet Loftus, representing PEHP, told the Retirement and Independent Entities Committee on Oct. 25 that HCR 2—legislation from the previous session—has been implemented so that manufacturer rebates on prescription drugs can reduce member out-of-pocket costs at the point of sale.

Loftus described the change as shifting rebates from an after-the-fact, plan-level recovery to an instant reduction in the member's price at the pharmacy. "What this bill does is it makes rebates available to members as an instant rebate rather than to the health plan as a mail in rebate," he said.

Using examples discussed in the presentation, Loftus said Emgality carries a pharmacy sticker price of roughly $711 per month and that a manufacturer rebate near $395 effectively reduces the net cost to about $315 per month after the rebate. He said the program has prevented state employees on HSA ("star") plans from paying the higher sticker price until the plan later recoups rebates: "The important thing is the patient is only the patient is only paying what they should pay for the drug based on the fact that the rebate's gonna come in, and we can subtract that." Loftus reported that PEHP has returned an estimated $1,140,000 to members since July, averaging about $300,000 a month so far.

Loftus and committee members described how sharing rules change after members meet deductibles: before deductible, the member may receive the full rebate benefit at point of sale; after deductible the rebate is shared according to plan cost-sharing (Loftus used illustrative examples during the presentation).

Representative Thurston and Senator Phil Moore asked clarifying questions about whether the program was already operating; Loftus confirmed HCR 2's provisions were in force and PEHP is implementing the point-of-sale rebate approach. Committee members praised the approach as a patient-centered change that reduces front-end costs for people who must purchase specialty medications.

No committee action or vote was taken on this update; it was presented as a report on implementation of prior legislation.