Follow the Dollar: Flow of Payment for a $100 Blood Pressure Medicine

Janet is enrolled in a commercial health insurance plan and has a $40.00 copay for her blood pressure medicine. Because Janet’s health plan receives a 25% rebate off of the list price of her medicine, her copayment of $40.00 is slightly more than the $38.00 net price paid by her health plan. After rebates and fees, the manufacturer retains $62.00, roughly two-thirds of the original list price of $100.00.