Maybe surprisingly, the reply is PBMs, not drug producers. That is among the conclusions mentioned in a latest commentary by Good and Hernandez (2021). They attempt to unravel this query, writing:

Most explanations for growing drug prices begin with drug corporations, and certainly they’re a straightforward goal. Producers within the US are allowed to set their very own value for brand spanking new merchandise, that are then shielded from competitors by patent exclusivity…record costs of branded medication elevated at a yearly common of 9.1% from 2007 to 2018…
Nevertheless, growing record costs of medicine are partially mediated by ever-increasing reductions. Thus, drug producers level to the online value of medicine (the price of medication in any case reductions have been utilized) relatively than the record value as representing a extra correct determine of drug prices…earlier analyses point out that reductions on branded merchandise accounted for 60% the rise in drug prices from 2007 to 2018

Extra empirical particulars are supplied in a paper by Van Nuys et al. (2021). Utilizing an strategy much like what was used to trace circulation of funds by the drug distribution system general (Sood et al. 2017), they discover that:

Between 2014 and 2018, imply record costs of 32 insulin merchandise elevated by 40.1% (from $19.60 to $27.45), whereas imply web costs acquired by producers decreased by 30.8% (from $10.53 to $7.29). Web expenditures per 100 items of insulin elevated by 3.2% (from $15.11 to $15.59) whereas the share of a hypothetical $100 insulin expenditure accruing to producers decreased by 33.0% (from $69.71 to $46.73) and the share accruing to well being plans decreased by 24.7% (from $13.82 to $10.40). The share of insulin expenditures retained by pharmacy profit managers elevated by 154.6% (from $5.64 to $14.36), the share retained by pharmacies elevated by 228.8% (from $6.21 to $20.42), and the share retained by wholesalers elevated by 74.7% (from $4.63 to $8.09).

Briefly, intermediaries (PBMs, pharmacies) are gaining growing share of the insulin value relative to drug producers. The graphics under are courtesy of JAMA. Do learn your complete paper right here.

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