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.
Over the past couple weeks, we’ve been reflecting more on how neat Bloomberg’s Ohio Medicaid markup bubble chart was in their recent article, “The Secret Drug Pricing System Middlemen use to Rake in Millions.” We’re kicking ourselves now that we neglected to delve deeper into this in our report, “Bloomberg Puts Drug Pricing ‘Markups’ on the Map”. But like fine wine, good visualizations only get better with time, so it took us a few weeks to fully realize the possibilities that such data analysis could open up. Bloomberg’s excellent visualization does, however, leave a few open questions. What do other state Medicaid managed care programs look like? How do they compare to state fee-for-service programs? What do all states look like? To answer these questions, we set out to build a new visualization dashboard to compare drug markups between state Medicaid programs. We call our creation the “Medicaid Markup Universe” (because it looks very celestial). In this new visualization tool, we found a disturbingly large difference in drug markups across generic drugs in state Medicaid managed care programs, resulting in a slew of warped incentives that pressure supply chain members to value certain medications over others, and thus, certain patients over others.