![]() ![]() These transactions typically involve price concessions in the form of discounts or rebates, as well as other fees. ![]() Between the initial manufacturing and ultimate dispensing of a given drug product, numerous transactions must take place among manufacturers, wholesalers, pharmacies, pharmacy benefit managers (“PBMs”), providers, and payers. For Americans that either do not have insurance or have inadequate coverage to support their drug purchasing needs, a number of public safety net programs or private assistance programs (including manufacturer assistance) may be available to ensure access to needed medications.ĭrug prices are highly dependent on the complexities of the U.S. All plans implement various cost containment measures which may impact plan beneficiaries’ access to certain drug products. Private plans, which cover far more Americans than public plans, have more flexibility to make coverage and reimbursement determinations. The largest government-funded programs are Medicare and Medicaid, under which plans are subject to detailed requirements set forth by statute or regulation. Whether a drug product is covered, and at what price, is determined by each payer’s coverage, coding, and payment criteria for health insurance plans. ![]() health care system includes both private and public health insurance coverage. The United States (“U.S.”) accounts for the largest share of drug spending and innovation in the world, and its drug pricing regime is the most complex given its multi-payer model and unique overlay of market access requirements that collectively impact drug pricing and reimbursement decisions in the U.S. ![]()
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