Abstract
This cross-sectional study analyzes data on aggregate utilization and aggregate spending by patients and by pharmacy benefit managers to pharmacies for every brand-name drug prescription dispensed to all fully insured patients and some self-insured patients with commercial insurance in Massachusetts from 2015 to 2017.
Highlights
In 2019, one-quarter of persons living in the United States younger than 65 years of age reported that it was “difficult” to afford their prescription drugs.[1]
While a large portion (42.7%) of patient spending was for drugs in the highest price quartile, more than half (53%) of patient spending was for drugs in the second and third price quartiles
The OOP price for patients was more than 25% of the point-ofservice price for 41.3% of drugs in the second price quartile, for 5.4% of drugs in the third quartile, and for 1.1% of the top quartile
Summary
In 2019, one-quarter of persons living in the United States younger than 65 years of age reported that it was “difficult” to afford their prescription drugs.[1] High drug costs for patients have been associated with worse medication adherence—which may lead to poor health—and with poor financial outcomes for patients.[2] Several policy proposals are considering forms of drug price regulation for the highestpriced drugs to slow the increase in drug spending. Understanding how these policies may affect the affordability of medications for patients requires evidence of actual patient out-of-pocket (OOP) prices,[3] and understanding how prescription drug prices translate into OOP prices. We investigated out-ofpocket prices for brand-name drugs, growth in these prices over time, and how these prices translated into patient spending
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