12 September 2016 - The public reproach over the price of Mylan’s EpiPen is the latest imbroglio in a much broader debate over  costs of medicines in the US.

At issue is the rising list price on medicines. But as Mylan argued, these high reported prices often bear little relation to the real price actually paid, after rebates and discounts, by most health plans.

The question is how to bring more prudence to this complex system, in which discounts don’t flow evenly to the patients who need access to these medicines.

Mylan has pointed to a long sequence of drug supply middlemen who get a series of rebates, mostly as economic inducements for helping drug makers sell their medicines. To fund these rebates, drug makers push up the list price of their pills, only to furtively pay much of the money back to pharmacy benefit managers later.

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