| The US list prices are, well, a complicated matter.
For non-US readers, it is important to note that 80% of the customers
(who has insurance) don't pay the list price, but rather an
much more reasonable over-the-counter price. Due to the system of insurance companies and PBMs in the US
the list price is often high. When PBMs a are negotiating with the pharmaceutical companies,
they have an incentive to keep a high list price. Let's say the PBMs
and a pharmaceutical company negotiates for the price of a drug X. If the pharmaceutical company lowers the price of the drug X,
and there are other comparable drugs from other companies on the market,
then there is a risk that the PBM simply drops the drug X from their lists.
Instead, they make a better deal (for them) on drug Y. For the company producing X, being omitted from the insurance companies lists,
is bad business. As an outsider, it is difficult to understand that the US keeps the private insurance layer and the PBMS. Now - the insurance companies also don't pay list prices.
They get a rebate. But they - and here my memory fails me - the
get some money from ... the government based on the list price. Look at the congress hearings on the high medicine prices on YouTube. |