Estimation of the Share of Net Expenditures on Insulin Captured by US Manufacturers, Wholesalers, Pharmacy Benefit Managers, Pharmacies, and Health Plans From 2014 to 2018.

Importance: Recent US media and policy attention on insulin affordability has focused on the role of manufacturers in setting prices; however, the role of other drug distribution intermediaries in determining prices has received less attention.

Objective: To estimate the share of net expenditures on insulin captured by manufacturers, wholesalers, pharmacy benefit managers, pharmacies, and health plans from 2014 to 2018.

Design Setting And Participants: This cross-sectional study of the US insulin market was conducted in 2020 using 2014-2018 data from multiple sources, including list and estimated net prices from SSR Health for 32 insulin products, mean use weights from a commercial pharmacy claims database, mean acquisition costs and reimbursements from the Centers for Medicare & Medicaid Services, mean spread and share of rebates retained by pharmacy benefit managers from state Medicaid and drug transparency reports, and profit margins from the public filings of distribution system participant companies.

Comparison of Spending on Common Generic Drugs by Medicare vs Costco Members.

This cross-sectional study uses 2017 and 2018 Medicare Part D clams to compare the amount Medicare pays for common generic prescriptions in Part D with prices available to patients without insurance at Costco.

Uptake of Infliximab Biosimilars Among the Medicare Population.

This cross-sectional study uses Medicare data to examine the uptake of Inflectra and Renflexis, and investigates physician prescribing behavior in switching between biologic and biosimilar versions.

Provider differences in biosimilar uptake in the filgrastim market.

Objectives: To identify differences in biosimilar uptake across providers and to examine the association between provider biosimilar uptake and observable practice-level characteristics.

Study Design: A retrospective analysis of 100% of a commercial medical claims database from June 2015 to June 2018.

Methods: We focused on providers of biologic (Neupogen) and biosimilar (Zarxio) filgrastim.

Frequency and Magnitude of Co-payments Exceeding Prescription Drug Costs.

This study uses Centers for Medicare & Medicaid Services data to assess the proportion of pharmacy claims with patient co-pay overpayment and the mean dollar amount of overpayment in 2013.