Abstract
High and continually increasing pharmaceutical drug spending is a major health and health policy concern in the United States. To demonstrate trends in prices among popular brand-name prescription drugs. This economic evaluation of drug prices focuses on 49 top-selling brand-name medications in the United States. Pharmacy claims data from January 1, 2012, through December 31, 2017, were obtained from Blue Cross Blue Shield Axis, a database that includes data from more than 35 million individuals with private pharmaceutical insurance. Drugs that exceeded $500 million in US sales or $1 billion in worldwide sales were examined. The median sum of out-of-pocket and insurance costs paid by patients or insurers for common prescriptions, presented annually and monthly, was the primary outcome. In total, 132 brand-name prescription drugs were identified in 2017 that met the inclusion criteria. Of this total, the study focused on 49 top-selling drugs that exceeded 100 000 pharmacy claims. Substantial cost increases among these drugs was near universal, with a 76% median cost increase from January 2012 through December 2017, and almost all drugs (48 [98%]) displaying regular annual or biannual price increases. Of the 36 drugs that have been available since 2012, 28 (78%) have seen an increase in insurer and out-of-pocket costs by more than 50%, and 16 (44%) have more than doubled in price. Insulins (ie, Novolog, Humalog, and Lantus) and tumor necrosis factor inhibitors (ie, Humira and Enbrel) demonstrated highly correlated price increases, coinciding with some of the largest growth in drug costs. Relative price changes did not differ between drugs that entered the market in the past 3 to 6 years and those that have been on the market longer (number of drugs, 13 vs 36; median, 29% increase from January 2015 through December 2017; P = .81) nor between drugs with or without a Food and Drug Administration-approved therapeutic equivalent (number of drugs, 17 vs 32; median, 79% vs 73%; P = .21). Changes in prices paid were highly correlated with third-party estimates of changes in drug net prices (ρ = 0.55; P = 3.8 × 10-5), suggesting that the current rebate system, which incentivizes high list prices and greater reliance on rebates, increases overall costs. The growth of drug spending in the United States associated with government-protected market exclusivity is likely to continue; greater price transparency is warranted.
Highlights
Pharmaceutical drug net spending in the United States reached $324 billion in 2017 and is expected to increase 2% to 5% annually over the 5 years.[1]
Relative price changes did not differ between drugs that entered the market in the past 3 to 6 years and those that have been on the market longer nor between drugs with or without a Food and Drug Administration–approved therapeutic equivalent
Changes in prices paid were highly correlated with third-party estimates of changes in drug net prices (ρ = 0.55; P = 3.8 × 10−5), suggesting that the current rebate system, which incentivizes high list prices and greater reliance on rebates, increases overall costs
Summary
Pharmaceutical drug net spending in the United States reached $324 billion in 2017 and is expected to increase 2% to 5% annually over the 5 years.[1]. In the United States, most of the insured population typically only directly pays through a copayment insurance program, and the full drug costs are generally not realized beyond the purchase of shared benefit plans from private insurers (often supplemented by employers) or payment of taxes that fund public insurers. For those among the 12.1% of uninsured or underinsured adults,[7] out-of-pocket costs can be crippling or catastrophic. Manufacturers may set list prices independently of pharmacy benefit managers, and they may do so at any time for any number of reasons, ranging from benign rationale (eg, manufacturing cost increase) to allegations of illegal practice.[12,13,14,15]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
