A recent headline announcing plans to transition commercial clients to a “rebate-free” model, passing previously negotiated drugs savings directly to members at the point of sale, marks yet another potential shift in the pharmacy landscape.
The new proposed model underscores how quickly the industry is continuing to evolve and could reshape how plan sponsors, payers, employers, health plans, and health systems define value in 2026 and beyond.
A Shift Toward Simplicity and Predictability
This new approach reflects an ongoing push to simplify benefit structures and improve affordability for patients that aligns with the current push from FTC, lawmakers, and public sentiment for increased regulation.
This new approach includes plans to:
- Pass savings directly to patients at the point of sale through a new “net cost” model.
- Introduce new reporting and accountability measures tied to customer satisfaction.
- Roll out the program first to fully insured clients in 2027, with broader implementation beginning in 2028.
This model reflects an attempt to streamline complex rebate systems and provide greater alignment between drug pricing, benefit design, and member experience.
Questions Still Taking Shape
This approach raises questions about how the proposed model will work once implemented and how it might impact both plan economics and the overall rebate strategy.
Some key questions remain, such as:
- Comparative value: How will point-of-sale pricing compare to the traditional rebate model over time?
- Adoption flexibility: How will organizations decide between the legacy model and the new one, and what factors will drive that choice?
- Market ripple effects: How will manufacturers, payers, and PBMs adjust their pricing and contract strategies in response?
The key takeaway? Many operational and economic details are still unclear.
Gateway’s Perspective
At Gateway Health Partners, we see this as an opportunity towards greater clarity and accountability across the industry; something we already bring to our clients and partners every day. It is also a reminder that agility and insight are more important now than ever in today’s market.
Our solutions are built for adaptability, and with a foundation rooted in clarity, value, and client advocacy, we remain well-positioned to guide our partners through this next phase of market change.
That means:
- Offering customized formulary and rebate strategies that are flexible.
- Providing expert guidance as the market shifts and new models emerge and evolve.
- Advocating for solutions that balance cost, access and long-term value.
Yes, the marketplace is changing, but Gateway remains dedicated to helping clients navigate these changes with confidence.
Looking Ahead
As we move into 2026 and beyond, legislative reform and clarity will continue to shape the future of our market. But it also invites important conversations about what real “value” means for clients and patients.
We believe the organizations that will thrive will be those that stay proactive, informed, and aligned with industry experts that understand the nuances behind the headlines.
At Gateway, we’re not just waiting to see how it plays out; we’re actively helping our clients prepare for what’s next.
Have questions? We’d love to partner with you to help find solutions. Contact Scott Webb at [email protected]
