Drug prices

Read it this way Every bar clears the peer-parity line by more than double, ranging from 2.34x for Imbruvica to 3.68x for Eliquis. These are 2018 brand-name prices only, so they overstate the US premium overall since US generic prices run below the peer average. Use this chart to identify which price layer is visible and why the recommendation requires separating gross, net, rebate, and buyer-specific prices before acting.

Caveat 2018 prices. The 256 percent headline is for brand-name drugs only. US generic prices are below the peer average.

RAND, International Prescription Drug Price Comparisons (RR-2956) · 2018 · source

Read it this way As in the headline hero chart, US per-person drug spending is the highest shown and sits well above the $816 peer-median line. This is total per-capita spending, not price per prescription, so it also reflects how much medicine Americans use. Use this chart to identify which price layer is visible and why the recommendation requires separating gross, net, rebate, and buyer-specific prices before acting.

OECD Health Statistics via KFF Health System Tracker · 2022 · source

Read it this way The list-price line stays above the net-price line every year, and in 2020 net growth even went negative while list kept climbing. The gap between the two lines is the rebate, so a rising list price alone does not mean patients or payers actually paid more. Use this chart to identify which price layer is visible and why the recommendation requires separating gross, net, rebate, and buyer-specific prices before acting.

IQVIA Institute, protected-brand list vs net price growth · 2023 · source

Read it this way Endocrine and blood-modifier bars sit well above the 23 percent all-Part-D average, while oncology and immunology sit far below it at 2 and 5 percent. A low rebate share is what lets list-price increases pass through nearly unrebated, in the same classes shown climbing in the list-vs-net line beside it. Use this chart to identify which price layer is visible and why the recommendation requires separating gross, net, rebate, and buyer-specific prices before acting.

Caveat Medicare Part D 2021 data (GAO), not commercial. This differs in basis from the IQVIA protected-brand list-vs-net line beside it.

GAO, Medicare Part D rebates by therapeutic class (GAO-23-105270) · 2021 · source

Read it this way Medicaid's net price is roughly a third of Medicare's for standard brand drugs and well under half for specialty drugs, even though both figures are already net of rebates. The gap shows how much buyer leverage, not underlying cost, can move the price of the identical drug. Use this chart to identify which price layer is visible and why the recommendation requires separating gross, net, rebate, and buyer-specific prices before acting.

Caveat CBO analysis of 176 top-selling brand drugs, 2021. Both figures are already net of each program's rebates, so this is a leverage comparison, not a list-vs-net gap.

CBO, Prices for Brand-Name Drugs Under Selected Federal Programs · 2021 · source

Read it this way Both federal transaction benchmarks sit well below the AWP list line, at 80 and 74 percent, showing list price is rarely what anyone actually pays. Generic ASP falling to 32 percent shows the gap widens far more once a drug loses exclusivity. Use this chart to identify which price layer is visible and why the recommendation requires separating gross, net, rebate, and buyer-specific prices before acting.

Caveat OIG findings. ASP is a Part B benchmark, not a Medicaid measure, included to show how far list prices sit above transaction prices across federal programs.

HHS Office of Inspector General, AMP and ASP relative to AWP · 2021 · source

Read it this way Eliquis alone accounts for more Part D gross spending than the next two drugs combined, and these top drugs are part of the 37.4 percent share flagged in the KPI above. The figures are gross cost before manufacturer rebates, so net spending is lower. Use this chart to identify which price layer is visible and why the recommendation requires separating gross, net, rebate, and buyer-specific prices before acting.

Caveat Gross cost, before manufacturer rebates, which CMS is barred from publishing. Net spending is lower.

CMS, Medicare Part D Spending by Drug · 2022 · source

Read it this way Points cluster into two groups: high-volume, moderate-cost drugs like Eliquis and Jardiance sit toward the bottom right, while low-volume, extreme-cost drugs like Revlimid and Pomalyst sit toward the top left. Both groups can produce similar total spending, but they call for different fixes, volume-based negotiation for one, price caps for the other. Use this chart to identify which price layer is visible and why the recommendation requires separating gross, net, rebate, and buyer-specific prices before acting.

Caveat Axes are linear, so the mass-market drugs bunch to the right. Total spending per drug is in the table, not the dot size.

CMS, Medicare Part D Spending by Drug · 2022 · source

Read it this way Eliquis climbed from $4.99B to $15.22B and Jardiance from $0.67B to $5.85B over just five years. This growth in gross spending is the pressure behind Medicare's first negotiated-price round shown in the next chart. Use this chart to identify which price layer is visible and why the recommendation requires separating gross, net, rebate, and buyer-specific prices before acting.

CMS, Medicare Part D Spending by Drug · 2022 · source

Read it this way List-price cuts range from 38 percent for Imbruvica to 79 percent for Januvia, but the caveat notes CMS estimated the true average cut after existing rebates at about 22 percent. The bars measure list-price relief, not the smaller net savings for drugs that were already heavily rebated. Use this chart to identify which price layer is visible and why the recommendation requires separating gross, net, rebate, and buyer-specific prices before acting.

Caveat These are reductions off list price. CMS estimated the average net reduction, after existing rebates, at about 22 percent.

CMS, Medicare Drug Price Negotiation Program, negotiated prices for 2026 · 2024 · source