New Medicare Part D 'Ski Slope' shows seniors' wild drug pricing ride

It’s the middle of July. A time of year for pool parties, barbecues, campfires. and generally sweating your butt off. It’s a relaxing time of year for the majority of us. But what about the ski bums out there? It’s a long six months (five if you are lucky) until the first big dump of the year. At 46brooklyn, we sympathize with people who are impatiently waiting for things – except rather than waiting to shred the gnar, we’ve been anxiously waiting to shred through Medicare Part D drug pricing data. Good news, drug pricing enthusiasts; we have a big (data) dump for you! After months of work on our newest drug pricing tool, we are pleased to release the new Medicare Part D Drug Pricing Ski Slope dashboard. In this viz, we give you the ability to select one of many drugs (brand and generic, oral solid and non-oral solid), and view the price set by thousands of Part D plans for your selected drug. For good measure, we added a line to show you the true market-based cost of the drug (based on NADAC), so you can see how frustratingly random Part D pricing is by different plans for the same drug. So get your balaclava on and join us as we traverse the Part D drug pricing slopes.

New drug pricing analysis reveals where PBMs and pharmacies make their money

For the first time in our existence, CMS has released drug pricing data that overlaps with the date of our launch. As we ripped open the data and examined CMS’ gift, we found some major changes in the way that the state of Ohio reported their data – and it has revealed some eye-opening information about PBM and pharmacy margins on prescription drugs. Given all the drug pricing noise out of Ohio, and the federal heat on PBM “spread pricing,” we decided to do a deep dive into what’s happening in Ohio, and how its new data provides incredible clues to determine where the money flows within the drug supply chain.

D is for Distortion: Medicare Part D's $2 Billion Problem

Over the last nine months we have sliced and diced generic drug pricing within Medicaid managed care to arrive at the conclusion that generic prices in Medicaid are subject to wild and seemingly arbitrary distortions. But the million dollar (or should we say $2 billion dollar) question is whether this problem is isolated to Medicaid, or if it is a broader issue plaguing Medicare Part D and Commercial plans as well? We now attempt to bring data into the fold to help answer this question. In this report, we embark on an in depth investigation into the pricing of the top 15 generic drugs in Medicare Part D - drugs that represented roughly a third of overall Part D generic spending in 2017. It turns out that the same arbitrary generic pricing behavior we have observed in Medicaid is alive and well within Part D. If you make it all the way to this report, you will be rewarded with all the math that estimates this problem to be worth over $2 billion in 2017.

Ben LinkMarch 20, 2019Medicare, Gleevec, Imatinib, Abilify, Aripiprazole, NADAC, Medicaid, AWP, Esomeprazole, Omeprazole

Examining high drug markups: Introducing the Top 20 over $20

We’re told that drug prices are too high, but who actually is setting the price and where does the money end up going? CMS recently updated their State Utilization databases, which track what state Medicaid programs are being charged for prescription drugs. Most notably, they extended the 2018 data to include the second quarter. We have updated our datasets and visualizations to track the changes in drug markups relative to their actual costs. We’ve studied up and have come up with our “Top 20 over $20” list. In other words, the top 20 drugs dispensed through Medicaid managed care organizations (MCOs) with a markup in of over $20 per prescription. Think of it as a “top 40 under 40” list for generic drugs, with the main difference being that no self-respecting generic drug wants to be on this list. Check out our new visualization that highlights the drugs that are busting the budgets of state Medicaid programs.