Prescription drugs—list price, net price, and the rebate caught in the middle

JAMA

6 March 2019 - Pharmacy benefit managers, such as Express Scripts, CVS Caremark, and Optum Rx, are some of the larger companies that administer the Medicare Part D prescription drug benefit. 

These companies facilitate access to prescription drugs for beneficiaries, and because each company generally has millions of enrolees, they leverage their size to extract price concessions from pharmaceutical manufacturers. Because Medicare is not permitted to negotiate drug prices directly, the program and beneficiaries rely on pharmacy benefit managers to negotiate on their behalf.

Although the federal Medicare program bears most of the costs of the Part D benefit, Medicare beneficiaries also pay for Part D through monthly premiums and out-of-pocket payments when they obtain prescription medications (ie, deductibles, co-insurance, or co-payments).

Read JAMA Viewpoint

Michael Wonder

Posted by:

Michael Wonder