[bradleyjg]

> If you're interested in roughly what the wholesale price is plus a very small markup

What about the rebates mentioned in the article several times? I know in the car industry one trick is to go on and on about "dealer invoice" and how great a deal you are getting while ignoring that rebates make that number fairly meaningless.

[kellanem]

Two things going on with the rebates.

1. I think the article is a little one sided in their explanation of the rebate system, though it certainly more opaque than it should be. (some of which is just healthtech is stuck in the dark ages)

2. The rebates really only apply to the branded meds, which are approximately 20% of the market.

[mattieuga]

I think that's very dismissive of the importance rebates play. The PBMs' defensibility comes almost entirely from their ability to use their scale to drive up branded/specialty medication costs up by demanding larger and larger rebates from pharma. In terms of revenue, branded and specialty meds already make up more than 75% of the market today. They are the real problem here, not generics.

[bradleyjg]

With all due respect, saying the article is a little one sided doesn't tell me much. Can you outline what the other side of the story is?

[kellanem]

The story isn't _good_, it's just a bit more complicated.

The pharma company's trade association published this recently which talks about it in depth: http://www.phrma.org/report/commercially-insured-patients-pa...