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

Brand drug launch prices: A game of perspective

Ben LinkMarch 9, 2023Rebates, Launch, drug prices, Brand drugs, Inflation Reduction Act, Medicare, Lyrica, WAC, Adbry, Firazyr, Zolgensma, Trikafta, CPI, List prices

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

Wreck-fidera: How Medicare Part D has hidden the benefits of generic competition for a blockbuster Multiple Sclerosis treatment

Ben LinkDecember 1, 2021Medicare, Copaxone, Teva, Rebates, Tecfidera, Biogen, Multiple Sclerosis, WAC, Mylan, NADAC, specialty drugs, Kaiser, CVS, UnitedHealthcare, Cigna, Anthem, Humana, Centene, DIR fees, AWP, Plan Finder

The Flawed Design of Medicare Part D: A Copaxone Case Study

Ben LinkAugust 12, 2020Copaxone, glatiramer, Medicare, Part D, PBM, specialty drugs, Gleevec, ACA, Drug prices, Teva, Mylan, Sandoz, Deductible, Rebates, DIR fees

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.

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.