title: A Review of US Drug Costs Relevant to Medicare, Medicaid, and Commercial Insurers Post-Affordable Care Act Enactment, 2010-2016.
abstract: Since passage of the Affordable Care Act (ACA) in 2010, US stakeholders are increasingly being held accountable for the value of healthcare services and drugs administered to patients. Pharmacoeconomic analyses offer one method of demonstrating a product's value, yet there is a lack of resources specific to US drug costs relevant to each stakeholder. The aim of this study was to review current US drug costs (post-ACA). A literature review aimed at finding evidence on outpatient prescription drug costs was performed using the following sources: PubMed, governmental agencies, news websites, the Academy of Managed Care Pharmacy (AMCP) website, and Google Scholar. Articles were limited to those published in the years "2010-2016" and the "English" language, and those that described drug acquisition costs, reimbursement costs, and rebates or discounting for Medicare, Medicaid, and commercial payors. The Drug Cost Focus Group (DCFG) was convened to supplement the literature review; the DCFG provided their expertise on US drug costs and emerging issues affecting drug costs. ACA legislation increased drug rebates for manufacturers participating in the Medicaid Drug Rebate Program. Acquisition costs commonly referred to in the literature include the wholesale acquisition cost and average manufacture price. Drugs reimbursed by Medicaid are currently based on the actual acquisition cost and ACA-Federal Upper Limit. Evidence suggests that reimbursement methods in the public market are varied. Current gaps in the literature regarding commercial insurers' drug costs (post-ACA) present barriers to the application of relevant drug costs to pharmacoeconomic analyses.
authors: Thomas Jefferson University, 901 Walnut St., Philadelphia, PA, 19107, USA. jacquelyn.mcrae@jefferson.edu.
authors: Jacquelyn
authors: J
authors: McRae
authors: Institute for Integrated Healthcare, and Access Market Intelligence, PO Box 17217, Greenville, SC, 29606, USA.
authors: F Randy
authors: FR
authors: Vogenberg
authors: Express Scripts, 1 Express Scripts Way, St. Louis, MO, 63121, USA.
authors: Silky Webb
authors: SW
authors: Beaty
authors: Truven Health Analytics, Croton Road Corporate Center, Croton Rd #350, King of Prussia, PA, 19406, USA.
authors: Elizabeth
authors: E
authors: Mearns
authors: Thomas Jefferson University, 901 Walnut St., Philadelphia, PA, 19107, USA.
authors: Stefan
authors: S
authors: Varga
authors: Thomas Jefferson University, 901 Walnut St., Philadelphia, PA, 19107, USA.
authors: Laura
authors: L
authors: Pizzi
mesh_terms: D016527:Drug Costs; D017850:Economics, Pharmaceutical; D006801:Humans; D007343:Insurance Carriers / Q000191:economics; D007356:Insurance, Pharmaceutical Services / Q000191:economics; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D058991:Patient Protection and Affordable Care Act; D055553:Prescription Drugs / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000191:economics; D014481:United States
chemical_list: D055553:Prescription Drugs