Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics
As a Pharmacist I often see how costs can be unnecessarily higher than need be. Somewhere where costs are much higher than they should be is when a generic of a medication does come out it is often not on PBM formularies sometimes for extended periods of time. One example of this I can think of off the top of my head is Seroquel XR. This brand drug costs well over $1000 for a bottle of 60 tablets. There is a generic for this medication that I believe was released in November of 2016 and as of today is priced at less than $200 for a bottle of 60. One of the "big 3" PBMs which I will not name still requires the brand. Although I cannot speak for certain as to why this is as PBM practices are not regulated to any extent and have no transparency regarding their pricing/rebates, my professional opinion (and that of many others) is that it continues like this because the PBM receives a large rebate from the manufacturer. Again, speculation, but I do not believe that some if any of this rebate is passed off to the patient or sponsor based on not hearing any of my patient having received any types of benefits and instead pushed into the "Donut Hole" and then catastrophic coverage sooner. This leads to higher patient costs, higher third party sponsor costs as well and higher Medicare costs once the catastrophic coverage has been reached. I urge you as an independent pharmacy owner to look into how PBMs deal with us, drug companies, patients, etc. Take a good look and I believe you will see where the higher costs of healthcare is coming from.