Tuesday, May 21, 2024
HomeHealth InsurancePBMs or drug producers? – Healthcare Economist

PBMs or drug producers? – Healthcare Economist


For those who guessed producers, you’ll be incorrect. At the very least that’s in response to a brand new research by Mattingly et al. (2023) in JAMA Well being Discussion board. Utilizing a pattern of the 45 generic medicine with >$100m in Half D and utilized by >1m beneficiaries, the authors discovered that:

…Medicare Half D spent $11.8 billion for 690 million claims (imply, $22.50 per declare; 95% CI, $18.28-$26.72 per declare), representing 5.5% of all Half D spending ($216 billion) in 2021. The $22.50 was distributed as follows: $9.18 (40.8%) represents PBM gross revenue; $3.87 (17.2%), pharmacy gross revenue; $2.71 (12.0%), wholesaler gross revenue; and $6.73 (29.9%), producer income. Whole middleman gross revenue (PBM, wholesaler, and pharmacy) ranged from −12.3% to 88.6% of Medicare Half D spending.

The total paper is right here.



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