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Importance High out-of-pocket drug costs can cause patients to skip treatment and worsen outcomes, and high insurer drug payments could increase premiums. Drug wholesale list prices have doubled in recent years. However, because of manufacturer discounts and rebates, the extent to which increases in wholesale list prices are associated with amounts paid by patients and insurers is poorly characterized. Objective To determine whether increases in wholesale list prices are associated with increases in amounts paid by patients and insurers for branded medications. Design, Setting, and Participants Cross-sectional retrospective study analyzing pharmacy claims for patients younger than 65 years in the IBM MarketScan Commercial Database and pricing data from SSR Health, LLC, between January 1, 2010, and December 31, 2016. Pharmacy claims analyzed represent claims of employees and dependents participating in employer health benefit programs belonging to large employers. Rebate data were estimated from sales data from publicly traded companies. Analysis focused on the top 5 patent-protected specialty and 9 traditional brand-name medications with the highest total drug expenditures by commercial insurers nationwide in 2014. Data were analyzed from July 2017 to July 2020. Exposures Calendar year. Main Outcomes and Measures Changes in inflation-adjusted amounts paid by patients and insurers for branded medications. Results In this analysis of 14.4 million pharmacy claims made by 1.8 million patients from 2010-2016, median drug wholesale list price increased by 129% (interquartile range [IQR], 78%-133%), while median insurance payments increased by 64% (IQR, 28%-120%) and out-of-pocket costs increased by 53% (IQR, 42%-82%). The mean percentage of wholesale list price accounted for by discounts increased from 17% in 2010 to 21% in 2016, and the mean percentage of wholesale list price accounted for by rebates increased from 22% in 2010 to 24% in 2016. For specialty medications, median patient out-of-pocket costs increased by 85% (IQR, 73%-88%) from 2010 to 2016 after adjustment for inflation and 42% (IQR, 25%-53%) for nonspecialty medications. During that same period, insurer payments increased by 116% for specialty medications (IQR, 100%-127%) and 28% for nonspecialty medications (IQR, 5%-34%). Conclusions and Relevance This study's findings suggest that drug list prices more than doubled over a 7-year study period. Despite rising manufacturer discounts and rebates, these price increases were associated with large increases in patient out-of-pocket costs and insurer payments. [ABSTRACT FROM AUTHOR]

The article discusses that which drug prices should Medicare negotiate. It mentions that there are draft pieces of legislation and regulation that take aim at the rising cost of drugs; and also mentions to make selective price negotiation work, Medicare would have to focus on drugs that are on the market solely under accelerated approval.

An editorial is presented on the prices of branded specialty drugs in the pharmaceutical industry. Topics mentioned include the incremental cost-effectiveness of statin therapy with ezetimibe or evolocumab, the benefits of treatment and the increase spending on prescription drugs for chronic diseases.

The article discusses how copay assistance may further increase health care costs. Topics covered include the consistent growth in drug spending, the practice by pharmaceutical companies of offering coupons to offset patients' out-of-pocket costs, and the tendency for copay assistance to undermine benefit designs that enable low-cost insurance plans. Also mentioned are the policy changes that should be done to ensure that the equity of copay assistance programs is improved.

The article examines the reasons for increases in cancer-drug prices and spending. It focuses on the U.S. social insurance program Medicare and the legislative and regulatory framework that shields cancer drugs from strategies to keep the prices down. Medicare's strategies including control of utilization and encouraging price competition among manufacturers of interchangeable drugs are discussed. The negotiating leverage of drug plans under Medicare's Part D program is also examined. Laws and regulations which inhibit the flexibility of Medicare are discussed, including provisions of the law which affect drug coverage and laws which undo strategies that depend on the interchangeability of cancer drugs.

In this Viewpoint, Peter Bach and colleagues distinguish 5 pricing reform proposals implied by the concept of value-based drug pricing and discuss the potential of each to ensure value in response to unsustainable drug price increases. [ABSTRACT FROM AUTHOR]

The author discussed the pricing for cancer drugs. Topics discussed include the spending on specialty drugs in 2013, Medicare price for eight cancer drugs approved by the U.S. Food and Drug Administration (FDA) in 2013, the author's claim that the price of the drug is not linked to its benefits and the formulary determinations used by the National Institute for Health and Care Excellence (NICE) of Great Britain to consider the effectiveness and cost of drugs.

The author reflects on the aspects of the reformation of the payment system for medical oncology. He mentions that the three cancer payment reform approaches have been proposed including episode-based payment, payment for pathway adherence and third-party buy-and-bill that address the link between cancer drug prices and physician profits.

The author reflects on the U.S. Federal Drug discount program called "340B" that allowed some hospitals to buy drugs at a low price to treat their patients. He informs that the program requires the drug manufacturers to extend substantial discounts on drugs administered in the outpatient setting, including oral drugs. He further informs that the typical discount ranges from 30 percent to 50 percent off the drug's list price.

A response by Doctor Peter B. Bach to a letter to the editor about his article "Indication-specific Pricing for Cancer Drugs" in an early 2015 issue is presented.