Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania.
Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, Pennsylvania.
JAMA. 2020 Mar 3;323(9):854-862. doi: 10.1001/jama.2020.1012.
Most studies that have examined drug prices have focused on list prices, without accounting for manufacturer rebates and other discounts, which have substantially increased in the last decade.
To describe changes in list prices, net prices, and discounts for branded pharmaceutical products for which US sales are reported by publicly traded companies, and to determine the extent to which list price increases were offset by increases in discounts.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective descriptive study using 2007-2018 pricing data from the investment firm SSR Health for branded products available before January 2007 with US sales reported by publicly traded companies (n = 602 drugs). Net prices were estimated by compiling company-reported sales for each product and number of units sold in the US.
Calendar year.
Outcomes included list and net prices and discounts in Medicaid and other payers. List prices represent manufacturers' price to wholesalers or direct purchasers but do not account for discounts. Net prices represent revenue per unit of the product after all manufacturer concessions are accounted for (including rebates, coupon cards, and any other discount). Means of outcomes were calculated each year for the overall sample and 6 therapeutic classes, weighting each product by utilization and adjusting for inflation.
From 2007 to 2018, list prices increased by 159% (95% CI, 137%-181%), or 9.1% per year, while net prices increased by 60% (95% CI, 36%-84%), or 4.5% per year, with stable net prices between 2015 and 2018. Discounts increased from 40% to 76% in Medicaid and from 23% to 51% for other payers. Increases in discounts offset 62% of list price increases. There was large variability across classes. Multiple sclerosis treatments (n = 4) had the greatest increases in list (439%) and net (157%) prices. List prices of lipid-lowering agents (n = 11) increased by 278% and net prices by 95%. List prices of tumor necrosis factor inhibitors (n = 3) increased by 166% and net prices by 73%. List prices of insulins (n = 7) increased by 262%, and net prices by 51%. List prices of noninsulin antidiabetic agents (n = 10) increased by 165%, and net prices decreased by 1%. List price increases were lowest (59%) for antineoplastic agents (n = 44), but discounts only offset 41% of list price increases, leading to 35% increase in net prices.
In this analysis of branded drugs in the US from 2007 to 2018, mean increases in list and net prices were substantial, although discounts offset an estimated 62% of list price increases with substantial variation across classes.
大多数研究药品价格的研究都集中在目录价格上，没有考虑制造商回扣和其他折扣，这些折扣在过去十年中大幅增加。
描述美国销售的品牌药品的目录价格、净价格和折扣的变化情况，并确定目录价格上涨在多大程度上被折扣增加所抵消。
设计、设置和参与者：使用 SSR Health 投资公司 2007-2018 年的定价数据进行回顾性描述性研究，这些数据来自于截至 2007 年之前在美国销售的、由上市公司报告的品牌药品（n=602 种药物）。净价格通过汇总公司对每种产品的报告销售和在美国销售的单位数量来估算。
日历年度。
结果包括医疗补助和其他支付者的目录和净价格以及折扣。目录价格代表制造商向批发商或直接购买者的价格，但不包括折扣。净价格代表产品的单位收入，扣除所有制造商的优惠（包括回扣、优惠券和任何其他折扣）。每年对整个样本和 6 个治疗类别计算结果的平均值，根据使用情况对每种产品进行加权，并对通货膨胀进行调整。
从 2007 年到 2018 年，目录价格上涨了 159%（95%置信区间，137%-181%），即每年上涨 9.1%，而净价格上涨了 60%（95%置信区间，36%-84%），即每年上涨 4.5%，2015 年至 2018 年净价格稳定。在医疗补助中，折扣从 40%增加到 76%，在其他支付者中从 23%增加到 51%。折扣的增加抵消了目录价格上涨的 62%。各个类别之间存在很大的差异。多发性硬化症治疗药物（n=4）的目录价格（439%）和净价格（157%）涨幅最大。降脂药物（n=11）的目录价格上涨了 278%，净价格上涨了 95%。肿瘤坏死因子抑制剂（n=3）的目录价格上涨了 166%，净价格上涨了 73%。胰岛素（n=7）的目录价格上涨了 262%，净价格上涨了 51%。非胰岛素抗糖尿病药物（n=10）的目录价格上涨了 165%，净价格下降了 1%。抗肿瘤药物（n=44）的目录价格涨幅最低（59%），但折扣仅抵消了目录价格涨幅的 41%，导致净价格上涨了 35%。
在对 2007 年至 2018 年美国品牌药品的分析中，目录价格和净价格的平均涨幅都很大，尽管折扣在很大程度上抵消了估计的 62%的目录价格涨幅，但各个类别之间存在很大差异。
