UnitedHealthcare (UHC) announced plans to share the pharmacy discounts it gets from drug manufacturers to more than 7 million people enrolled in its fully insured commercial group benefit plans, beginning Jan. 1, 2019. The new program is designed to lessen out-of-pocket costs by applying these drug rebates up front, at the time of sale.

UHC’s CEO, Dan Schumacher, said “the benefit could range from a few dollars to a few hundred dollars,” mostly affecting consumers with high-deductible plans who buy drugs carrying large rebates.

This is one of the moves that insurers like UHC have made to ameliorate discontent among consumers, employer groups and lawmakers, in the face of increasing public pressure over the pricing of pharmaceuticals. 

“UnitedHealthcare is uniquely positioned to deliver new value and clarity to health care, and pharmacy benefits in particular,” Schumacher said.

In general, health insurers have resisted the idea of passing on these savings, especially for Medicare drug plans, as they argue that much of the money from the discounts goes toward lowering premiums for all customers.

Separately, UHC rolled out a nationwide policy on March 1 with regard to reviewing and adjusting facility claims for the most severe and costly ED visits for members enrolled in commercial and Medicare Advantage plans.

UnitedHealthcare’s policy is aimed at lowering overall spending on ED claims for the insurer, as well as to ensure accurate coding for providers. For analysis of claims, UHC will use the Optum ED Claim analyzer tool to determine appropriate coding levels for Level 4 and 5 patients.

Indianapolis-based Anthem rolled out a similar policy to reduce ED visit spending, but has been denying coverage for billed ED visits after the fact. With both insurers rolling out similar policies, this could lead to hospitals and providers having their claims adjusted to a lower claim or outright denied, seeing many patients down-coded to Level 3, and experiencing a cut to their bottom line.


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