Effective January 1, 2024, CarelonRx will change the way it reconciles rebate guarantees for our ASO clients on National, Traditional, and Essential formularies, as well as clients on other formularies with minimum rebate guarantees.
This change is due to a new provision in the American Rescue Plan Act (ARPA) that takes effect on January 1, 2024. The provision affects drug manufacturers’ obligations to Medicaid, and some manufacturers are responding by lowering their list prices across the market on certain medications, including insulin.
These new lower prices mean the respective prescription drug rebates will be lower too. Therefore, when reconciling rebate guarantees, CarelonRx will apply rebate credits to account for the decrease in the drugs’ list prices.
We will be emailing clients affected by this change on November 9, 2023. If you have questions about this change or need specific information about how the new methodology will affect your clients, please contact your Anthem or CarelonRx representative.