Title: A Primer on Brand-Name Prescription Drug Reimbursement in the US
In a recent paper by Hernandez and Hung (2024), the intricacies of drug reimbursement in the US are thoroughly examined. The article delves into the key players involved in the process and provides valuable insights.
The Players:
– Manufacturers: Research, develop, and bring new drug products to the market.
– Wholesalers: Act as distributors of drug products, purchasing from manufacturers and distributing to pharmacies and healthcare providers.
– Pharmacies: Dispense prescription drugs to patients, including retail, mail-order, online, specialty, and institutional pharmacies.
– Health Care Providers: Prescribe and administer all prescription drugs, both self-administered and those requiring professional supervision.
– Patients: Consumers of drug products from healthcare providers or pharmacies.
– Health Plans or Insurers: Provide coverage for medical and pharmacy services to members, funded by employers, employees, or tax dollars in the case of public insurance.
– Pharmacy Benefit Managers (PBMs): Administer the pharmacy benefit of insurance policies, design formularies, negotiate discounts with manufacturers, and process claims.
– Group Purchasing Organizations (GPOs): Aggregate purchasing power among members to negotiate better discounts.
– Pharmacy Services Administrative Organizations: Manage contracts with PBMs on behalf of independent pharmacies.
Flow of Funds for Drug Coverage:
The flow of funds for drugs covered by the pharmacy benefit and medical benefit is explained in detail, along with the role of pharmacies and medical providers.
Looking Forward:
Key themes identified in the article include rising drug prices, increased government drug price negotiation, vertical integration, and the shifting of specialty provider-administered drugs to the pharmacy benefit.
For more in-depth information, readers are encouraged to read the full article at the provided link.
