Prescription Drug Prices Research Articles

Availability and Pricing of Drugs Prescribed by Otolaryngologists Through a Direct-to-Consumer Pharmacy: Medicare Savings Implications.

High prescription drug prices can financially strain patients and insurers, with substantial clinical repercussions. In recent years, direct-to-consumer (DTC) pharmacies have emerged as potentially lower-cost alternatives for patients to fill prescriptions. We evaluated whether drugs commonly prescribed by otolaryngologists were available at a national DTC pharmacy (Mark Cuban Cost Plus Drug Company [MCCPDC]) and estimated potential Medicare savings from DTC pricing. We identified drugs and prices paid by Medicare Part D plans using the 2021 Drug Spending Dashboard. Our analysis included 16 generic drugs within the MCCPDC formulary, which offered lower prices for 14 (87.5%) drugs. If plans had secured MCCPDC pricing for all 16 drugs, Medicare patients and plans would have saved $2.9 billion (relative reduction: 62.3%) in 2021. Estimated total savings were greatest for budesonide-formoterol ($1.9 billion), dexlansoprazole ($464.6 million), and levothyroxine ($327.4 million). Otolaryngologists and insurers may consider utilizing DTC pharmacies with lower drug prices, though patients may face challenges projecting out-of-pocket costs across pharmacies, medications, benefit phases, and formulary tiers.

The tipping point: Financial and emotional costs of care for Medicare patients with cancer.

260 Background: As cancer-related health care expenses are increasing, a greater proportion of treatment costs are shifting directly to the patient, resulting in an increased financial burden for many patients. In addition to growing healthcare costs, the inflationary environment in the US has also increased the costs of daily living expenses. Although the Inflation Reduction Act (IRA) encompasses measures for negotiating prices of specific high-cost medications within Medicare Parts B and D, given the expenses associated with cancer treatment IRA negotiation provisions will likely have limited impact on patients’ financial burden. We sought to capture the financial and emotional experiences of Medicare cancer patients about their costs of care prior to the implementation of the IRA. Methods: This cross-sectional analysis used data from a nationwide survey distributed in February 2024 by Patient Advocate Foundation (PAF). Inclusion criteria included a valid email address, age >19, self-reported cancer diagnosis and Medicare coverage. Frequencies were calculated for categorical variables. Additional information about financial challenges will be collected on a subset of cancer survey respondents in May 2024. Results: A total of 331 survey respondents with cancer completed the survey. Most respondents were female (61%), age≥56 (86%), white (73%), retired (59%), married (47%), household income <$48,000 (69%), and rural location (24%). The most common cancer types were multiple myeloma (47%) and breast (26%); 25% were diagnosed < 2 years prior, 87% were receiving cancer treatment and 52% experienced financial challenges prior to diagnosis. Almost half (45%) reported a negative change in their financial situation in the past 12 months; caused by increased living (63%), food (60%), medical care (47%) and medication (39%) costs. Overwhelming/above average financial stress (40%) was reported on the day of the survey; 30% reported spending at least 25% of their monthly income on medical costs; 69% reported financial burden due to their illness. Fifty-nine percent reported that finances impacted their emotional wellbeing. Common coping strategies to alleviate financial distress included positive attitudes, family/friend support and spiritual beliefs. Conclusions: To mitigate the impact of inflation on low-income cancer patients, it is essential for policymakers, healthcare providers, and community organizations to work together to ensure access to affordable healthcare, support services, and financial assistance programs. Additionally, raising awareness about the challenges faced by this vulnerable population and advocating for policies that address their needs can help alleviate some of the burdens imposed by inflation. While the IRA is a step in the right direction, its financial impact on patients appears limited.

A cost-minimization analysis of anti-VEGFs for the treatment of neovascular age-related macular degeneration in the Netherlands.

Age-related macular degeneration (AMD) is the main cause of severe vision loss globally. Neovascular AMD (nAMD) is an advanced stage of AMD treated with anti-vascular endothelial growth factors (anti-VEGFs). Although anti-VEGF treatment is effective, the frequent intravitreal injections place a burden on patients, (in)formal caregivers, and clinics. This study assesses the health-economic impact of anti-VEGF agents with lower injection frequency that have the potential to reduce treatment burden and compares it to the standard of care. We developed a cost-minimization model to evaluate the direct medical costs associated with first-line unilateral anti-VEGF treatment across a 3-year time horizon in the Netherlands. The analysis compared aflibercept 8mg, aflibercept 2mg, bevacizumab, faricimab, and ranibizumab. Our model adopted a treat-and-extend (T&E) regimen for aflibercept 2mg, bevacizumab, and ranibizumab. For aflibercept 8mg, a flexible regimen that was extendable up to 24weeks was applied, while faricimab followed a flexible regimen that was extendable up to 16weeks. Additionally, since list prices may vary from net prices, we calculated the break-even price for each anti-VEGF in comparison to bevacizumab, which is the recommended first-line treatment due to its low medication price. Based on list prices, aflibercept 8mg led to the lowest treatment costs (€16,251 per patient over a 3-year time horizon), closely followed by bevacizumab (€17,616 per patient over a 3-year time horizon). Ranibizumab led to the highest per-patient costs (€31,746 over a 3-year time horizon). For bevacizumab, most costs were attributable to administration, while for the other anti-VEGFs, most were attributable to medication. Aflibercept 8mg is cost-saving compared to bevacizumab at their medication prices at the time of writing. Aflibercept 2mg, faricimab, and ranibizumab should be priced below €488, €591, and €75, respectively. To be cost-equal to bevacizumab with current list prices, anti-VEGFs should be administered with a maximum of 12.7 to 13.8 injections over a 3-year time horizon. According to the injection frequency observed in clinical trials, aflibercept 8mg would be the anti-VEGF that generates the lowest per-patient healthcare costs for the treatment of nAMD in the Netherlands after a treatment period of three years. Our study indicates that anti-VEGF drugs with a lower injection frequency might provide a cost-saving solution to the increasing burden of anti-VEGF treatment on the healthcare system.

A Comparative Analysis of International Drug Price Negotiation Frameworks: An Interview Study of Key Stakeholders.

In 2022, Congress passed the Inflation Reduction Act, which allowed Medicare, for the first time, to begin negotiating the prices for certain high-cost brand-name prescription drugs. Many other industrialized countries negotiate drug prices, and we sought to compare and contrast key features of the negotiation process across several health systems. We focused, in particular, on the criteria for selecting drugs for price negotiation, procedures for negotiation, factors that influence negotiated prices, and how prices are implemented. We included four G7 countries in our analysis (Canada, France, Germany, and the United Kingdom [England]), two Benelux countries (Belgium and the Netherlands), and one Scandinavian country (Norway) with long-established frameworks for drug price negotiation. We also analyzed the Veterans Affairs Health System in the United States. For each system, we gathered relevant legislation, government publications, and guidelines to understand negotiation frameworks, and we reached out to key drug price negotiators in each system to conduct semistructured interviews. All interviews were recorded, transcribed, and coded, and data were analyzed based on an internal assessment tool that we developed. All eight systems negotiate the prices of brand-name prescription drugs soon after approval and rely on formal clinical assessments that compare newly approved drugs with existing therapies. Systems in our study differed on characteristics such as whether the body performing clinical assessments is separate from the negotiating authority, how added health benefit is assessed, whether explicit willingness-to-pay thresholds are employed, and how specific approaches for priority disease areas are taken. High-income countries around the world adopt different approaches to conducting price negotiations on brand-name drugs but coalesce around a set of practices that will largely be absent from the current Medicare negotiation framework. US policymakers might consider adding some of these characteristics in the future to improve negotiation outcomes.

Economic perspectives in pharmaceuticals: market dynamics and pricing of medications

Background: Analysing the modern pharmaceutical market is crucial for making management decisions, forming strategies, and ensuring competitiveness in this sector. Aim: Determination of the impact of various economic factors of the pharmaceutical industry on market conditions and development of economically justified areas of cost formation in the pharmaceutical market. Materials and Methods: A systematic review of scientific publications in the search databases Scopus, Web of Science, Medline, and Google Scholar was conducted. Statistical research methods used are observation, index and regression analysis. The methods of benchmarking analysis and interpretation were applied. Results: A detailed examination of published works by scientists and doctors has highlighted critical problems in forming the cost of medicinal products in the pharmaceutical market. The use of medicines worldwide and in individual countries has been considered, and a trend of increasing revenue in the global pharmaceutical market has been identified. The main approaches to forming pricing models in the pharmaceutical industry have been summarised. The peculiarities of the formation of EU legislation on the registration, production, sale, and quality control of medicinal products have been highlighted. The characteristics of the functioning of reimbursement programmes in certain countries worldwide have been described. A benchmarking analysis of the pharmaceutical market economy in Ukraine and the European Union has been conducted. Conclusions: The main directions for improving pricing policy in the modern pharmaceutical market have been outlined. It has been established that the main directions for forming the cost of medicinal products are expenses on research and development, costs of goods sold and patent expenses, marketing and advertising, regulatory and permitting procedures, and market competition.

Cost analysis study of price variation among the various brands of proton pump inhibitors available in Benghazi-Libya

Background: A large proportion of patients in developing countries have to pay out of pocket for their medications. The prices of different brands of the same medications vary considerably and may vary from one community pharmacy to another. This study was undertaken to evaluate the variation in costs of proton pump inhibitors (PPI) and histamine H2-receptor antagonists available in Libya. Methods: Prices of various brands of PPI and various formulations were collected from four community pharmacies in the city of Benghazi. Both cost ratio and percentage variation were calculated and compared for various brands of the same strength and number of tablets, capsules, injections, or syrups. Results: The highest cost ratio and percentage price variation were found with omeprazole 20 mg, followed by omeprazole 40 mg. Other significant cost variations (>100%) were seen with pantoprazole 40 mg, Downoprazol (omeprazole + sodium bicarbonate) 40 mg, and esomeprazole 40 mg. Ampoules of omeprazole, cimetidine, and ranitidine had cost ratios of 1:1.7, 1:1.7, and 1:1.8, and cost variation ratios of 71.4, 66.7, and 75, respectively. Variations in prices of PPI and histamine H2 antagonists from the same manufacturer between different community pharmacies were common. The highest percentage cost variation (100) was seen with omeprazole 20 mg. Conclusions: Due to political instability, the prices of all drugs are controlled by importing private companies and the owners of community pharmacies instead of governmental authorities, that leads to cost variations. Therefore, the health authorities exert strict control on pricing of medications.

Artificial Intelligence in Drug Identification and Validation: A Scoping Review.

The end-to-end process in the discovery of drugs involves therapeutic candidate identification, validation of identified targets, identification of hit compound series, lead identification and optimization, characterization, and formulation and development. The process is lengthy, expensive, tedious, and inefficient, with a large attrition rate for novel drug discovery. Today, the pharmaceutical industry is focused on improving the drug discovery process. Finding and selecting acceptable drug candidates effectively can significantly impact the price and profitability of new medications. Aside from the cost, there is a need to reduce the end-to-end process time, limiting the number of experiments at various stages. To achieve this, artificial intelligence (AI) has been utilized at various stages of drug discovery. The present study aims to identify the recent work that has developed AI-based models at various stages of drug discovery, identify the stages that need more concern, present the taxonomy of AI methods in drug discovery, and provide research opportunities. From January 2016 to September 1, 2023, the study identified all publications that were cited in the electronic databases including Scopus, NCBI PubMed, MEDLINE, Anthropology Plus, Embase, APA PsycInfo, SOCIndex, and CINAHL. Utilising a standardized form, data were extracted, and presented possible research prospects based on the analysis of the extracted data.

Lexical Relations in Joe Biden's Speech about Plan to Lower Prescription Drugs Cost: Semantics Study

The purpose of this research is to analyze the types of lexical relations and the types of meanings of lexical relations that appear in Joe Biden's Speech about the plan to reduce prescription drug prices. The method used in this research is qualitative method. The results of this research show that there are eight types of lexical relations and three types of semantic meanings; the types of lexical relations show that from 30 data that have been analyzed, eight synonym data (26.7%), ten antonym data (33.3%), three meronym data (10%), two polysemy data (6.7%), two hyponym data (6.7%), two member-collection data (6.7%), two portion-mass data (6.7%), and one homonym data (3.3%). Meanwhile, the types of semantic meanings found from 60 data that have been analyzed are 51 data of literal meaning (85%), 5 data of semi-idiomatic meaning (8.3%), and 4 data of fully idiomatic meaning (6.7%). Therefore, it can be concluded that the type of lexical relations that appears the most is antonyms at 33.3% and that the most common type of meaning is literal meaning, which is 85%. Keywords: Lexical relations, Semantics, Speech

Price transparency at the point of prescribing with real-time prescription benefits.

Real-time prescription benefits (RTPB) shows prescribers patient-, medication-, and pharmacy-specific information on medication pricing, prior authorization requirements, and lower-cost alternatives. RTPB is intended to improve patient satisfaction and prescription fill rates by decreasing out-of-pocket costs for prescriptions. Therefore, we evaluated how RTPB affects prescribing patterns by examining acceptance and subsequent fill rates for RTPB alternative suggestions. RTPB was implemented in February 2022 using external vendor interfaces. Prescribing data from March 2022 to March 2023 were analyzed. RTPB displayed alerts for medications requiring prior authorization or when alternative medications would result in cost savings. Patients were included if their prescription received an RTPB response and they had a subsequent encounter with pharmacy fill data. Primary outcomes were alert acceptance rates and prescription fill rates across RTPB alert groups, with a secondary outcome of monthly copay savings for accepted alerts. RTPB requests received a response for 88% of prescriptions, with price estimates provided for 77.9% of them. Lower-cost alternatives accounted for 67.2% of alerts, while prior authorization requirements represented 15% of alerts. Prescribers selected a lower-cost alternative 32% of the time. For those with an RTPB alert, patients filled prescriptions 68% of the time when an alternative was chosen, compared to 59% of the time when the original prescription was retained (odds ratio, 1.5; 95% confidence interval, 1.5-1.6; P < 0.001). Patients saved an average of $27.77 per month on copay costs when alternatives were selected. Implementation of RTPB was found to result in significant improvements in prescription fill rates and decrease patient copay costs, despite low alert acceptance rates.

Differential effect of China's Zero Markup Drug Policy on provider-induced demand in secondary and tertiary hospitals.

Following the marketization of China's health system in the 1980's, the government allowed public hospitals to markup the price of certain medications by 15% to compensate for reduced revenue from government subsidies. This incentivized clinicians to induce patient demand for drugs which resulted in higher patient out-of-pocket payments, higher overall medical expenditure, and poor health outcomes. In 2009, China introduced the Zero Markup Drug Policy (ZMDP) which eliminated the 15% markup. Using Shanghai as a case study, this paper analyzes emerging and existing evidence about the impact of ZMDP on hospital expenditure and revenue across secondary and tertiary public hospitals. We use data from 150 public hospitals across Shanghai to examine changes in hospital expenditure and revenue for various health services following the implementation of ZMDP. Our analysis suggests that, across both secondary and tertiary hospitals, the implementation of ZMDP reduced expenditure on drugs but increased expenditure on medical services, exams, and tests thereby increasing hospital revenue and keeping inpatient and outpatient costs unchanged. Moreover, our analysis suggests that tertiary facilities increased their revenue at a faster rate than secondary facilities, likely due to their ability to prescribe more advanced and, therefore, more costly procedures. While rigorous experimental designs are needed to confirm these findings, it appears that ZMDP has not reduced instances of medical expenditure provoked by provider-induced demand (PID) but rather shifted the effect of PID from one revenue source to another with differential effects in secondary vs. tertiary hospitals. Supplemental policies are likely needed to address PID and reduce patient costs.

Dermatology medications with the highest cost burden on Medicare Part D: Potential implications of the Inflation Reduction Act

Signed into law in August 2022, the Inflation Reduction Act includes provisions requiring the federal government to negotiate prices for medications covered under Medicare Part D. Initial negotiations will target drugs with the highest total spending and price increases relative to inflation. In this study, we identify dermatology prescriptions with the highest cost burden on Medicare Part D and analyze recent trends in total spending and unit costs.

Lessons From Insulin: Policy Prescriptions for Affordable Diabetes and Obesity Medications.

Escalating insulin prices have prompted public scrutiny of the practices of drug manufacturers, pharmacy benefit managers, health insurers, and pharmacies involved in production and distribution of medications. As a result, a series of policies have been proposed or enacted to improve insulin affordability and foster greater equity in access. These policies have implications for other diabetes and obesity therapeutics. Recent legislation, at both the state and federal level, has capped insulin out-of-pocket payments for some patients. Other legislation has targeted drug manufacturers directly in requiring rebates on drugs with price increases beyond inflation rates, an approach that may restrain price hikes for existing medications. In addition, government negotiation of drug pricing, a contentious issue, has gained traction, with the Inflation Reduction Act of 2022 permitting limited negotiation for certain high expenditure drugs without generic or biosimilar competition, including some insulin products and other diabetes medications. However, concerns persist that this may inadvertently encourage higher launch prices for new medications. Addressing barriers to competition has also been a priority such as through increased enforcement against anticompetitive practices (e.g., "product hopping") and reduced regulatory requirements for biosimilar development and market entry. A novel approach involves public production, exemplified by California's CalRx program, which aims to provide biosimilar insulins at significantly reduced prices. Achieving affordable and equitable access to insulin and other diabetes and obesity medications requires a multifaceted approach, involving state and federal intervention, ongoing policy evaluation and refinement, and critical examination of corporate influences in health care.

Survey of the Prices of Topical Compounded Medications for Alopecia in the Tri-State Area.

Currently, there is only one topical medication approved by the U.S. Food and Drug Administration for alopecia, minoxidil 2.5% and 5%. With limited options, dermatologists often turn to compounding pharmacies for customized topical alopecia medications. (1) to investigate the pricing and availabilities of compounded topical alopecia medications and (2) to investigate the delivery/mail options available. 103 dermatological compounding pharmacies in the tri-state area were contacted. Data were collected on the prices of 11 different compounded formulations for alopecia, the highest concentration of minoxidil available, compounding accreditation status, and delivery. The majority (76.7% [79/103]) of pharmacies surveyed were responsive. Mean prices for 60 g or mL of medication were $70.44 for minoxidil 5%, $86.95 for minoxidil 5%/finasteride 0.5%, $159.13 for minoxidil 5%/bimatoprost 0.03%, $141.91 for minoxidil 5%/latanoprost 0.02%, $75.31 for finasteride 0.5%, $204.41 for tacrolimus 0.3%, $220.11 for tacrolimus 0.3%/minoxidil 5%/clobetasol 0.05%, $71.44 for cetirizine 1%, $74.93 for metformin 10%, $4,273.20 for tofacitinib 2%, and $1,840.42 for ruxolitinib 2%.&nbsp;Nearly all (93.5% [72/77]) of the pharmacies reported being able to compound minoxidil higher than the commercially available 5%, while 67.6% (50/74) were able to customize minoxidil to be made with &lt;10% alcohol.&nbsp;Just over half (56.4% [44/78]) of the pharmacies were able to deliver to all tri-state areas. The mean delivery fee of pharmacies was $5.93 (n=77). Almost all of the pharmacies (98.7% [76/77]) claimed to be able to process and deliver medications within a week. If pharmacies were not located in the local vicinity, 44.6% (29/65) used a mailing service. This survey serves to expand clinicians' and patients' knowledge of the options and prices of topical compounded medications for alopecia. J Drugs Dermatol. 2024;23(3):&nbsp; &nbsp; &nbsp;doi:10.36849/JDD.7697.

Tramadol Abuse Among Adolescents: Analysis Based on Differential Association Theory in Tasikalaya Regency

Adolescents in Tasikalaya District show a tendency to be susceptible to Tramadol protection, a type of opioid analgesic commonly used to reduce moderate to severe pain. This phenomenon is a resource for the medical community, health practitioners, local governments and other related parties. Serious attention is needed to this problem to prevent negative impacts on the health and welfare of adolescents in the region. Coordinative efforts between the health, education and government sectors need to be strengthened to develop effective prevention and intervention strategies. A deep understanding of the factors driving Tramadol is key in designing appropriate preventive measures. This research examines the use of the drug tramadol among teenagers in Tasikalaya Regency using a qualitative approach and Differential Association Theory. The results of the study showed that adolescents' support for tramadol was caused by social and environmental factors, including interactions with peers and family members who also used the drug. Teenagers often rationalize their behavior and have certain attitudes that influence their decision to take tramadol. Apart from that, the easy availability of tramadol medication and affordable prices also influences teenagers' choices. This study provides a deeper understanding of the problem of tramadol among adolescents and suggests comprehensive preventive measures.

A principled approach to non-discrimination in cost-effectiveness

The US Inflation Reduction Act (IRA) prohibits the Centers for Medicare and Medicaid Services (CMS) from using standard quality-adjusted life-years or other value assessment methods that discriminate against the aged, terminally ill, or disabled when setting maximum fair prices for prescription drugs. This policy has reignited interest in methods for assessing value without discrimination. Equal value of life-years gained (EVL), healthy years in total (HYT), and Generalized Risk-Adjusted Cost-Effectiveness (GRACE) have emerged as proposals. Neither EVL nor HYT rests on well-articulated microeconomic foundations. We show that they produce decisions that are inconsistent over time in a variety of ways, including: (1) failure to support additivity and indirect comparison in cases where the standard-of-care therapy changes over time; (2) strictly negative value of survival gains that accrue from a new, better standard-of-care, particularly for the disabled themselves; (3) unbounded average value of survival gains; and (4) non-convex survival preferences. We propose an alternative method that relies on GRACE and its microeconomic foundations.

Budget impact analysis for three glucagon-like peptide-1 receptor agonist-based therapies for type 2 diabetes mellitus management in Saudi Arabia

Background and Objectives This study presents a budget impact analysis (BIA) conducted in Saudi Arabia, evaluating the cost implications of adopting semaglutide, tirzepatide, or dulaglutide in the management of type 2 diabetes mellitus (T2DM) patients. The analysis aims to assess the individual budgetary impact of these treatment options on healthcare budgets and provide insights for decision-makers. Methods A prevalence-based BIA was developed using real-world and clinical trials data. The model considered disease epidemiology, medication prices, diabetes management expenses, cardiovascular (CV) complications costs, and weight reduction savings over a 5-year time horizon. One-way and probabilistic sensitivity analyses (OWSA, PSA) were performed to assess the robustness of the results. Results Over a 5-year period, the cumulative budget impact for semaglutide, tirzepatide, and dulaglutide were 85,923,089 USD, 169,790,195 USD, and 94,558,356 USD, respectively. Hypothetical scenarios considering price parity between semaglutide and tirzepatide are associated with financial impacts of 85,923,091 USD and 86,475,335 USD, respectively. In the public sector, semaglutide showed the lowest incidence of 3-point major adverse CV events (3P-MACE), with tirzepatide leading in weight loss and HbA1c reduction, and dulaglutide presenting the highest 3P-MACE rates and least improvements in HbA1c and weight. A breakeven analysis suggested that tirzepatide’s list price would need to be $199.91 lower than its current list price to achieve budget impact parity with semaglutide based on currently available evidence. Results from the OWSA suggested that risk reductions for CV events were key drivers of budget impact. PSA results were confirmatory of base-case analyses. Conclusions CV cost-offsets and drug acquisition considerations may make semaglutide a favorable use of resources for Saudi budget planners and decision-makers. These results were robust to assumptions regarding the list price of tirzepatide.

(163) The High Price of Anonymity: Comparison of Cost of Direct-to-Consumer Mail Order Pharmacies Compared with Cost Plus Drug Company

Abstract Introduction Direct-to-consumer (DTC) mail order pharmacies often entice patients with erectile dysfunction (ED) by highlighting the ability to obtain medication online and avoid an “awkward” doctor’s visit. The markup and cost of obtaining medications for ED through subscription services from DTC pharmacies that include a “telemedicine” visit remains unknown. Objective To compare the cost of generic ED medications available from DTC mail order pharmacies to Mark Cuban Cost Plus Drug Company. Methods We obtained the cost of medications from three direct-to-consumer online mail order pharmacies (hims, BlueChew, and Roman) as well as comparable medications which are available with a prescription from Mark Cuban Cost Plus Drug Pharmacy. Cost per pill, monthly costs, and annual costs were compared in a variety of subscription options from DTC pharmacies compared with Cost Plus Drug Company. Results Introductory packages of sildenafil started at $25/month at BlueChew (30mg, 6 pills/month, $4.17/pill), $26/month at hims (25mg, 4 pills/month, $6.50/pill), and $16/month at Roman (25mg, 4 pills/month, $6.25/pill). Alternatively, 30 pills at Cost Plus Drug Company costs $9.40 (20mg, 30 pills/month, $0.32/pill). Introductory packages of tadalafil started at $25/month at BlueChew (6mg, 4 pills/month, $6.25/pill), $30/month at hims (10mg, 4 pills/month, $7.50/pill)), and $39/month at Roman (5mg, 4 pills/month, $9.75/pill). Alternatively, 30 pills at Cost Plus Drug Company was $10.70 (10mg, 30 pills/month, $0.36/pill). The cheapest per pill price of sildenafil is $2.79 at BlueChew (30mg), $4.00 at hims (25mg), and $2.80 at Roman (25mg). To obtain the lowest price, patients are required to commit to 34 pills/month at $90 from BlueChew, a 12-month subscription for 16 pills/month totaling $768 from hims, and a 12-month subscription of 10 pills/month totaling $336 from Roman. The cheapest cost/pill at Cost Plus Drug Company was $0.15/pill (20mg) to obtain 90 pills for $13.40. These values are even more stark when ordering the highest strength and highest quantity of tadalafil for 1 year from each of DTC pharmacy: BlueChew $1,445 (9mg, 28/month, $4.30/pill), hims $1,284 (10mg, 16/month, $6.69/pill), and Roman $5,136 (20mg, 10/month, $42.80/pill)). 360 tabs of Tadalafil 20mg from Cost Plus Drug Company cost $75.20, $0.21/pill). This analysis is limited as the cost of a doctor’s visit to obtain a prescription is not included in the price of medications at Cost Plus Drug Company but is included in the direct-to-consumer services. Conclusions Direct-to-consumer online pharmacies that include a telehealth appointment and provide access to generic medications to treat ED have considerable markup. This markup likely exceeds the out-of-pocket cost for a primary care office visit needed to obtain a prescription to treat ED. Prescribers should inform patients of cost-effective methods to obtain commonly used medications to treat ED. Disclosure No.

Survey and analysis of accessibility, availability, and affordability of topical glaucoma medicines.

Affordability and availability of medicines is a growing global challenge for health-care systems. Access to medicines is recognized as an important determinant of treatment adherence. The access to glaucoma medicines and how it affects glaucoma management are not known. The purpose of this study was to determine the availability, affordability, and accessibility of topical intraocular pressure (IOP) -lowering eye drops in Haryana state of northern India using the World Health Organization (WHO)/Health Action International (HAI) methods. A cross-sectional study was done to collect data on prices and availability of glaucoma topical medications in public and private sector pharmacies and retail outlets using the WHO/HAI methodology between October 2021 and January 2022. The availability and affordability of topical glaucoma medicines was determined. Comparison of the local price with international prices was done by calculating the median price ratio (MPR). A total of 191 facilities were randomly sampled across 11 ( n = 55) urban, 29 ( n = 92) semi-urban, and 44 ( n = 44) rural places during the study period. The availability of topical medication for glaucoma was low (35.7 ± 22.3) across all sampled sites and all classes of topical glaucoma medications. The median price of topical medication and availability were negatively correlated, Pearson's coefficient r (18) = -0.44, P 0.05, though the relationship was weak. A lowest paid, unskilled Indian government worker must spend between 15% and 203% of their daily wage to acquire a glaucoma medication. The availability and accessibility of topical glaucoma medications was low in this survey.

Is the Inflation Reduction Act Effective? A Forward-Looking Review of the IRA

This paper conducts an in-depth examination of the Inflation Reduction Act (IRA), significant legislation aimed at addressing a series of critical economic and climate issues in the United States. It introduces the concept of inflation and discusses the key provisions of the IRA across four major areas: climate change, energy security, prescription drug prices, and tax reforms. Additionally, the paper analyzes the Act’s overall impact on inflation separately, providing a comprehensive review of its effectiveness. The study evaluates the IRA through an analysis of economic data and news reports, considering the policy’s broader implications and offering suggestions for future research.

Net prices of new antiobesity medications.

Glucagon-like peptide-1 receptor agonists (GLP1s) are effective antiobesity drugs and the subject of intense debate around insurance coverage due to the large prevalence of obesity and overweight. The estimation of the budget impact associated with GLP1 insurance coverage requires estimates of GLP1 prices that account for manufacturer discounts. The authors applied a peer-reviewed method to estimate the net prices of GLP1s after manufacturer discounts. The authors estimated manufacturer discounts for each product as the difference between the gross sales estimated at list price and manufacturer-reported revenue. From this difference, the authors subtracted discounts to government programs, including 340B, Medicaid, and the Medicare Part D coverage gap, and attributed the remaining amount to manufacturer discounts provided in the commercial market. Manufacturer discounts for GLP1s approved for obesity were estimated at 41%, which translated into net prices of $717 to $761 per month of supply. Manufacturer discounts for GLP1s approved for type 2 diabetes ranged from 54% to 59%, which translated into net prices of $312 to $469 per month of supply. The magnitude of manufacturer discounts underscores the need to consider net price information in studies that inform private and public payers' decision-making around coverage of GLP1s for obesity.