Point of Sale Rebate Program from Blue Cross NC

November 28, 2018

 

To help members manage pharmacy cost increases, effective January 1, 2019 Blue Cross NC will be passing rebates directly back to members when they purchase rebated drugs.

The point of sale rebate program affects all fully insured plans and can affect some self-insured plans. Self-insured plans with custom benefits may have the ability to opt-in or opt-out of the rebate program.

Members may notice when picking up a prescription at their pharmacy that they are paying less. This is because of a rebate being applied at the point of sale. The rebate is dependent upon the drug manufacturer and not all drugs have a rebate. For drugs that do offer a rebate, the cost is lowered by the rebate value BEFORE member benefits are applied. The amount the member owes will NOT go below $0, so no cash rebate will be received by the member. The actual out-of-pocket amount will be credited towards a member’s deductible/out-of-pocket maximum, not the full cost before the rebate. Below are two examples of how the point of sale rebate program could work.

Example 1:
Total cost of drug: $300
Rebate amount $100
Member pays: $200
Amount applied to deductible/coinsurance: $200

Example 2:
Total cost of drug: $300
Rebate amount: $100
Member pays: $50 copay (member has $50 copay)
Amount applied to out-of-pocket maximum: $50 (lesser of rebated amount and copay)

EMPLOYEE COMMUNICATION

Below is a simplified message you can use to communicate this change with your employees

Point of Sale Rebate Program from Blue Cross NC

You may notice when picking up your next prescription at the pharmacy that you pay a little less. Rebates are currently used to offset premiums across the entire insurance pool and keep costs down and Blue Cross NC will be passing those rebates directly back to you when you purchase rebated drugs. This change goes into effect January 1, 2019.

Please note, the rebate is dependent upon the drug manufacturer and not all drugs have a rebate. For drugs that do offer a rebate, the cost will be lowered by the rebate value BEFORE your benefits are applied. The amount you owes will NOT go below $0, so no cash rebate will be received. Your actual out-of-pocket amount will be credited toward your deductible/out-of-pocket maximum, not the full cost before the rebate. Below are two examples of how the point of sale rebate program could work.

Example 1:
Total cost of drug: $300
Rebate amount $100
You pay: $200
Amount applied to deductible/coinsurance: $200

Example 2:
Total cost of drug: $300
Rebate amount: $100
You pay: $50 copay
Amount applied to out of pocket maximum: $50 (lesser of rebated amount and copay)

If you have any questions, please contact Human Resources.