This primer explains drug pricing benchmarks, impacting costs for public health insurance programs and patients.
The price of a prescription drug can be difficult to determine in the United States. Pricing benchmarks are reference points used to determine acquisition costs as drugs are physically moved through the supply chain, to reimburse pharmacies, to calculate rebates, and to determine patient payments. Public health insurance programs, including Medicare and Medicaid, leverage different pricing benchmarks to pay for drugs for their beneficiaries, and the same drug can vary in price by program. The goal of this primer is to explain the most commonly used drug pricing benchmarks and their current contexts for use.
No takes yet. Share an insight, caveat, or question.
Hung et al. (2025) studied this question.
Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context: