How PBMs distort and undermine specialty drug pricing guarantees

Ben LinkMay 10, 2023Specialty, WAC, AWP, specialty drugs, PBM, Brand drugs, Generic drugs, Effective rate, NADAC, Linda Cahn, CVS, Express Scripts, Optum, Emgality, Retevmo, Imatinib, Gleevec, Hyalgan, Medicaid, Medicare, Mark Cuban, Ohio

Medicare hits $200 billion in gross drug spend: Who gets the blame?

Ben LinkApril 11, 2022Medicare, Part D, Brand drugs, Generic drugs, Specialty, DIR fees, Rebates, PBM, Eliquis, Revlimid, Xarelto, Januvia, Trulicity, Imbruvica, Lantus, Jardiance, Humira, Ibrance, NADAC, atorvastatin, WAC

The hidden midyear 2019 price increases on brand name drugs

This summer, there was extensive media coverage on a large number of price increases on brand-name prescription drugs. However, when we examined CMS National Average Drug Acquisition Cost (NADAC) drug pricing data, we noticed that there were not many price increases at all. We had a hunch that the NADAC file must have been missing some of the price increases, so we dug into the data and discovered that it was missing prices on hundreds of drugs – many of which are specialty drugs. This report examines the limitations of our favorite publicly-available drug pricing benchmark, and how that benchmark can be improved to provide even better accountability to the drug supply chain.

Ben LinkAugust 22, 2019drug prices, WAC, NADAC, Specialty, Pharmacy

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.