High prescription drug list prices may increase out-of-pocket costs for Medicare beneficiaries, according to an article published in JAMA Internal Medicine.
Oftentimes, these patients — and Medicare — end up paying more for drugs, as the rebates only trickle down to the health plans and pharmacy benefit manufacturers. As drugmakers offer greater rebates to these middlemen, they must increase list prices to see a profit.
Drugmakers often justify list price increases by saying they don't represent the actual amount patients pay for a drug after rebates. However, the list price and rebates "can directly impact patient cost in a big way," Stacie Dusetzina, PhD, lead author and assistant professor at the University of North Carolina-Chapel Hill's pharmacy school, told STAT.
Medicare uses a drug's list price before rebates to calculate coverage for each patient — and sometimes out-of-pocket costs, too, according to Dr. Dusetzina.
"We've heard over the years that the list price doesn't really matter, that it's not the real price," she told STAT. "It matters."
The program also uses the list price to calculate how quickly patients reach the coverage gap where they must pay a larger portion of the drug's cost before Medicare picks up most of the tab. Higher list prices force patients into the coverage gap quicker, which drives up out-of-pocket costs and Medicare expenses, according to the report.
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