Nico Gabriel

Dec 2, 2024 | jamanetwork.com | Olivier J. Wouters |Sean Sullivan |Emma Cousin |Nico Gabriel

Drug Prices Negotiated by Medicare vs US Net Prices and Prices in Other Countries Strategies to Help Patients Navigate High Prescription Drug Costs Hussain S. Lalani, MD, MPH, MSc; Catherine S. Hwang, MD, MSPH; Aaron S. Kesselheim, MD, JD, MPH; Benjamin N.

Dec 5, 2023 | jamanetwork.com | Inmaculada Hernandez |Nico Gabriel

Pharmacy benefit managers (PBMs) manage prescription drug benefits on behalf of health insurers; PBMs negotiate reimbursements for drugs, which should cover drug acquisition cost and pharmacy’s cost to dispense. Studies in Medicaid suggest that some PBMs pay pharmacies unjustified excessive amounts for generics, as high as 10 times acquisition costs.1 By inflating the amount paid to pharmacies, PBMs make patients pay more because patient cost sharing is based on point-of-sale reimbursement.