Labeling And Generic Medicine : Pricing And Market Share

Generally consumers have very little bargaining power as medication is prescribed. Apart from US where there is pricing flexibility, governments in other markets enjoy substantial pricing leverage.

Finally, in a February 2012 proposed regulation, CMS proposed that state Medicaid agencies reimburse pharmacies for retail drugs based on actual acquisition cost. CMS recognized, however, that states may not be able to determine the actual price paid by a pharmacy for a drug billed to Medicaid, so it suggested that states survey pharmacies or rely on other data to calculate an average acquisition cost for drugs purchased and billed by retail community pharmacies. The article reviewed the association between benefit caps, prescription drug use, and the costs associated. It also detailed drug cost sharing, additional medical costs, and specific health outcomes. Using observational data, the studies analyzed the changes and did a cost comparison of outcomes at two points of time, before and after the pharmaceutical benefits changed. The article detailed the impact of pharmaceutical drugs was often difficult to analyze because some data analyzed utilization while others analyzed actual pharmaceutical spending. The data surrounding utilization compared as many as five factors such proportion

Under the existing federal Medicaid pharmacy benefit program, fee-for-service reimbursement rates for prescription drugs are based on the actual invoice cost of prescription drugs plus a reasonable professional dispensing fee. Any federal reforms to Medicaid which would allow states to set Medicaid pharmacy reimbursement rates below actual drug acquisition costs could seriously jeopardize Medicaid patient access to Medicaid drugs. Whether in a Medicaid managed care or fee-for-service setting, a Medicaid program that reimburses below actual drug costs raises a barrier that may limit or eliminate access points for patients to utilize their Medicaid drug benefits. Even with a cost-based drug reimbursement floor, Medicaid programs can fully avoid patient access barriers only through the addition of adequate dispensing fees that are more reflective of the cost to provide healthcare services in the

In 2010, the Affordable Care Act created a $250 rebate if the Medicare beneficiary was in the coverage gap. It also expanded coverage to the discounts given on brand name prescriptions. With reforms and improvement comes disadvantage to others. Beneficiaries and patients will be able to start saving more money, but it comes with a decline for the drug providers. According to Health Capital Consultants, “over ten years, closing the coverage gap may ultimately cost approximately $32 billion” and the pharmaceutical industry will be forced to take on most of this burden. These companies are paying for the flexibility they’re been given by MMA. They can “set their premiums, design their own formularies and are free to use cost management tools” and Medicare will reimburse plans for a “share of their drug costs.” (Guterman & Huynh ,

Medicare, one of the greatest purchasing clients in the medication industry, is not lawfully allowed to bargain first hand with companies for lower medication costs or best possible price. (Kounang, 2015)

The Medicare beneficiaries’ contribution to the coverage gap decreases each year, with the majority of cost absorbed by the government and the drug manufacturers. Drug manufacturers also agreed to pay a fee to the federal government health care programs on branded prescription drugs (BPD), based on its sales of BPD’s. There was an expansion of the Public Health Service Act (PHSA), that required drug manufactures to provide eligible entities with significantly reduced drug price. The PHSA, also expanded those entities such as free-standing cancer centers and critical access hospitals (CAH), that were eligible to participate in the 340B program In, addition they also agreed to increase rebates on sales of prescription drugs to the Medicaid program (Spats, 2010). The rebate was increased from 15.1 percent to 23.1 percent. In addition, drugs, such as those used for pediatric care and clotting factor drugs there was a 17.1% rebate. Perhaps, most importantly, the firms extended the rebates to Medicaid patients enrolled in Managed Care Organizations (MCO). This new agreement allows plans to negotiate rebates in addition to the new ones

Between 2001 and 2011, the average patient’s out-of-pocket (OOP) cost for brand-name prescriptions rose by more than 80% (Tungol, et al., 2012, p. 691). The increasing OOP costs have contributed to a decrease

Effective medication helps with the rising cost of health care. When medication is working, the patient’s visits to the hospital and doctor’s office will decrease. The cost of new medication is exceeding the buyer’s ability to pay for it, and pharmaceutical companies begin to lose money when the drug loses its patent. However, generic drugs become available for the medication, and patients can afford to purchase it to treat their disease or condition. National discussions with providers, payers, and health policy makers have seriously considered various solutions for mitigating drug cost, with the ultimate goal of allowing patients to access appropriate and necessary treatments (Li & Shane, 2017). The government no longer has to decide who gets the medication, and certain therapies because of cost. Insurance companies will now cover the drug in its generic form. On the other hand, the pharmaceutical companies can no longer profit from and generic drug, and are forced to make new and improved drugs for profit. The patient will benefit by getting the medication that is needed to have a better quality of

Each plan is also followed by a detailed chart that breaks down which tier each medication falls under, estimated full drug cost at each pharmacy, whether any special actions are to be taken to receive the medication. There are 5 tiers that these medications can fall into, and with each plan these medications either fall into tier 3, 4, or 5. Tier 3, also known as preferred brand, are brand-name drugs that don’t have a generic equivalent. Tier 4, also known as non-preferred brand, are the higher-priced brand-name and generic drugs not in a preferred tier. Tier 5, also known as specialty, are the most expensive drugs on the drug list. Looking at drug coverage information and the estimated full drug cost at a retail pharmacy for each plan, it

Once the limit for Part D Medicare benefits has been reached, patients are now responsible for the full cost of the drugs. Needless to say, for most people who have Medicare Part D, the donut hole presents unfortunate financial challenges. Inclusively, the additional funding for these provisions also raise prices at a rate higher than inflation. “Such a price-hike penalty already applies to brand medicines, and proposals to extend it to generics are under review by the Health and Human Services (HHS) Inspector General” (Wechsler, 2015, para 2). This change will discourage pharmaceutical companies from entering into specific drug classes, and provide fewer choices that will increase the patient’s reliance on older, originator products and drive up costs (Wechsler, 2015, para

A few key stakeholders include government, physicians, pharmaceutical and insurance companies, nurses and patients. The government plays a significant role in the provision of prescription drug pricing by “establishing

In recent years, rising drug prices in the United States raises have impacted patient access to medications, including potentially life-saving medications. It has become extremely difficult for patient to receive medications. The blame is being shifted from insurers, drug manufactures, and the government. Insurers are protesting that specialty drug costs are forcing them to jack up premiums. State Medicaid directors say spiking pharmacy costs are coercing them to make unfortunate coverage trade-offs. From the consumer’s perspective, there is a constant cycle of blame and no actual progress. Fortunately, there are possible solutions the US healthcare can implement to help alleviate rising drug costs; for example, an expedited Abbreviated

Thank you for your thoughts Danh. I am aware that Hy-Vee and Wal-Mart pharmacies offer a $4 generic list, but as a Hy-Vee pharmacy intern, I know that the list is limited. The patient does not benefit from such a promotion if their drug is not on the list. Hence, this common scenario is in conflict with the ethical principle of distributive justice. Additionally, I believe that pharmacists can only do so much in a given situation and the system for access to medications is disappointingly inadequate. Thus, I proposed the development of a centralized electronic system dedicated to maximizing access to medications for every patient.

While there is tremendous variation in stakeholder viewpoints regarding what pharmacare should look like and who should fund it, there is clear consensus on many overarching principles. Our reliance on prescription drugs as a key tool in the maintenance and restoration of health has increased greatly since the inception of Medicare. Our current fragmented approach for funding of therapies has led to

People over 65 may choose from multiple plans. Generic and brand name drugs are grouped into cost-sharing tiers. Tier 1 is a mix of both low cost preferred generic and preferred brand. It is the lowest-cost tier. Tier 2 includes preferred generic and some preferred brand drugs. This is a lower cost tier. Tier 3 includes preferred brand and non-preferred generic drugs. This is a middle-cost tier. Tier 4 includes non-preferred brand and generic drugs. This is a higher cost tier. And Tier 5 is a specialty tier. Very high cost, unique prescription drugs which may include special monitoring or require special handling. These may be brand or generic. This is the highest cost tier.