PBMs or drug manufacturers? – Healthcare Economist





If you guessed the manufacturers, you would be wrong. At least that’s what a new study from Mattingly et al. (2023) in JAMA Health Forum. Using a sample of the 45 generic drugs with >$100 million in Part D and used by >1 million beneficiaries, the authors found that:

…Medicare Part D spent $11.8 billion for 690 million claims (mean, $22.50 per claim; 95% CI, $18.28-$26.72 per claim), representing 5.5% of all Part D spending ($216 billion ) in 2021. The $22.50 was distributed as follows: $9.18 (40.8%) represents PBM’s gross profit; $3.87 (17.2%), pharmacy gross profit; $2.71 (12.0%), wholesale gross profit; and $6.73 (29.9%), manufacturer’s income. The total gross profit of intermediaries (PBM, wholesale, and pharmacy) ranged from -12.3% to 88.6% of Medicare Part D spending.

The full document is here.



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