The Medicare Differential Drug Pricing Experience tracker

The U.S. prescription drug pricing system is complex and often results in significant price variability in pricing experience for the same medications across different plans. Pharmacy benefit managers (PBMs) such as UnitedHealth Group's Optum Rx, Cigna's Express Scripts, and CVS Health's Caremark negotiate drug prices on behalf of insurers and collectively manage ~80% of U.S. prescriptions. However, even within plans managed by the same PBM, yielded drug prices can vary, leading to challenges in cost management for both patients, plan sponsors, and the government.

Public concern over high prescription drug costs is pervasive. An October 2024 survey found that more than half of Americans can’t predict what their drug costs will be. A KFF Health Poll from September 2024 found that 82% of adults consider prescription drug costs unreasonable. More than half of adults express worry about affording their family's prescription drug costs. Despite the passage of the Inflation Reduction Act in 2022, which includes provisions for Medicare to negotiate drug prices, public awareness remains low. The same KFF poll revealed that more than two years after the law's enactment, the public is unaware of its drug pricing provisions.

This fragmented pricing landscape creates challenges for both patients and policymakers, making it difficult to predict and manage drug costs effectively. Even outside government programs, employers have immense challenges grappling with the convoluted and opaque prescription drug supply chain. And while the employer marketplace is often plagued by a lack of access to materially actionable data, as we have shown with many of our previously built dashboards, data from government programs can provide incredibly useful insights on how our system generally works. And since many of the same companies who manage pharmacy benefits within government programs also provide similar services in the commercial sector, learnings from publicly-available drug pricing data can provide value to the broader marketplace at large.

With this in mind, our 46brooklyn Medicare Differential Drug Pricing Experience Mapper dashboard analyzes drug pricing complexity and inequity in some of the most granular detail to date. Primarily utilizing Q1 2024 CMS Medicare Quarterly Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information, which provides a quarter-by-quarter, plan-by-plan, region-by-region, and drug-by-drug pricing guidance from Medicare Part D plans, this tool offers an opportunity to visualize these drug pricing variances, identify patterns, and achieve greater transparency in prescription drug pricing for a program providing drug coverage to over 50 million Americans.

As you will notice below, unlike our other dashboards, this tool is loaded with so much data, that Tableau Public couldn’t handle the load, so we have embedded a brand version and generic version of the Q1 2024 data below. For future updates, add your email to our sign up form here.

Data Sources

CMS Quarterly Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information
- Used to source drug prices
CMS Enrollment Files
- Used in weighting calculations to enrollment
Mark Cuban Cost Plus Drug Company (MCCPDC) Pricing
- Used to make comparisons in drug pricing
National Average Drug Acquisition Cost (NADAC)
- Used to make comparisons in drug pricing to pharmacy acquisition costs
Texas Medicaid Drug Vendor File for June 2024
- Used to make comparisons in drug pricing to pharmacy acquisition costs
Part D Information for Drug Manufacturers
- Used to identify BIN/PCNs of Part D plans

How We Created Our Dataset

Read our accompanying launch report on this topic and tool here.

How to Use

Select a drug product (Note - dashboards are brand and generic specific; if you cannot find the drug in one dashboard try the other)
Select a desired calculation
Add any filters for state, PBM, Parent Organization, and/or Plan type

Update Frequency

Stay tuned.

Additional Reading

In November 2024, the Wall Street Journal released an excellent write-up on our tool’s insights from Q2 2024. You can check it out here.

Please view this visualization on a laptop/desktop, tablet, or if you are as into data as we are, an IMAX movie theater screen. It is a highly complex tool for a highly complex dataset and is not designed to be viewed on a smartphone, as it contains too much information to fit on the screen. If you must use on a phone, flip the phone landscape, squint your eyes really hard, and then use your Jedi powers to scroll around to see all of the content.