Joyce Geoffrey
Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA 90089, United States.
Department of Pharmaceutical and Health Economics, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA 90033, United States.
Health Aff Sch. 2025 Jun 25;3(7):qxaf126. doi: 10.1093/haschl/qxaf126. eCollection 2025 Jul.
Recent concerns over rising drug prices have focused on the role of pharmacy benefit managers or PBMs. While multiple players make up the pharmaceutical supply chain, PBMs are the conductors who effectively decide which drugs are covered and at what cost. Most PBM contracts tie their compensation to a percentage of a drug's list price, creating a financial incentive to favor high-cost, high-rebate drugs on plan formularies at the expense of lower-cost generics and biosimilars. Furthermore, the PBM industry is highly concentrated and vertically integrated with the country's largest health insurers, making it even harder to assess PBM performance and profitability. A simple analysis of annual drug spending at different reporting levels provides important insight into where the money goes and where savings could be achieved. We find that simply delinking compensation to the list price of a drug throughout the supply chain could reduce annual drug spending by more than $95b or nearly 15% of net spending without adversely affecting manufacturers' incentive to innovate.
近期对药品价格上涨的担忧集中在药品福利管理机构（PBMs）的作用上。虽然药品供应链由多个参与者组成，但PBMs是有效决定哪些药物被纳入医保以及费用多少的主导者。大多数PBM合同将其报酬与药品标价的一定比例挂钩，这就产生了一种经济激励，促使其在医保药品目录中青睐高成本、高回扣的药物，而牺牲了低成本的仿制药和生物类似药。此外，PBM行业高度集中，且与美国最大的健康保险公司垂直整合，这使得评估PBM的绩效和盈利能力变得更加困难。对不同报告层面的年度药品支出进行简单分析，能为资金流向何处以及何处可以实现节省提供重要见解。我们发现，在整个供应链中简单地将报酬与药品标价脱钩，每年可减少药品支出超过950亿美元，或净支出的近15%，且不会对制造商的创新激励产生不利影响。
