Abstract
In 2018, total health care spending in the United States reached $3.6 trillion dollars, of which $476.2 billion was spent on prescription medications.1 Prescription drug spending continues to rise, increasing 5.5% from 2017 to 2018.1 Retail pharmacy and mail-order prescriptions account for 69.7% of prescription drug spending.1 The system of drug prescribing and distribution involves multiple players and negotiating tools (Supplementary Table 1). Schulman and Dabora2 published a report tracking the flow of funds through 13 different pharmaceutical firms and found that 52% of revenue generated from their pharmaceutical sales was spent on sales promotions.
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