Changes in List Prices, Net Prices, and Discounts for Branded Drugs in the US, 2007-2018

Abstract

Importance: Most studies that have examined drug prices have focused on list prices, without accounting for manufacturer rebates and other discounts, which have substantially increased in the last decade.

Objective: To describe changes in list prices, net prices, and discounts for branded pharmaceutical products for which US sales are reported by publicly traded companies, and to determine the extent to which list price increases were offset by increases in discounts.

Design, setting, and participants: Retrospective descriptive study using 2007-2018 pricing data from the investment firm SSR Health for branded products available before January 2007 with US sales reported by publicly traded companies (n = 602 drugs). Net prices were estimated by compiling company-reported sales for each product and number of units sold in the US.

Exposures: Calendar year.

Main outcomes and measures: Outcomes included list and net prices and discounts in Medicaid and other payers. List prices represent manufacturers' price to wholesalers or direct purchasers but do not account for discounts. Net prices represent revenue per unit of the product after all manufacturer concessions are accounted for (including rebates, coupon cards, and any other discount). Means of outcomes were calculated each year for the overall sample and 6 therapeutic classes, weighting each product by utilization and adjusting for inflation.

Results: From 2007 to 2018, list prices increased by 159% (95% CI, 137%-181%), or 9.1% per year, while net prices increased by 60% (95% CI, 36%-84%), or 4.5% per year, with stable net prices between 2015 and 2018. Discounts increased from 40% to 76% in Medicaid and from 23% to 51% for other payers. Increases in discounts offset 62% of list price increases. There was large variability across classes. Multiple sclerosis treatments (n = 4) had the greatest increases in list (439%) and net (157%) prices. List prices of lipid-lowering agents (n = 11) increased by 278% and net prices by 95%. List prices of tumor necrosis factor inhibitors (n = 3) increased by 166% and net prices by 73%. List prices of insulins (n = 7) increased by 262%, and net prices by 51%. List prices of noninsulin antidiabetic agents (n = 10) increased by 165%, and net prices decreased by 1%. List price increases were lowest (59%) for antineoplastic agents (n = 44), but discounts only offset 41% of list price increases, leading to 35% increase in net prices.

Conclusions and relevance: In this analysis of branded drugs in the US from 2007 to 2018, mean increases in list and net prices were substantial, although discounts offset an estimated 62% of list price increases with substantial variation across classes.

Figure 1.. Changes in List Prices, Net Prices, and Discounts for the Overall Sample

A, Changes from 2007 to 2018 in list and net prices for branded products that were available in January 2007 and for which US sales were reported by publicly traded companies. Net prices are net of all concessions made by manufacturers including rebates, coupon cards, 340B discounts, prompt pay discounts, return provisions, and any other deductions captured in the reporting of net sales. B, Mean discounts in Medicaid and other payers. Discounts are calculated as (list price − net price)/list price.

Figure 2.. Changes in List Prices, Net Prices, and Discounts for Multiple Sclerosis Therapies, Insulins, and Lipid-Lowering Agents

A, Changes from 2007 to 2018 in list and net prices for branded multiple sclerosis agents (left), insulins (middle), and lipid-lowering agents (right) that were available in January 2007 and for which US sales were reported by publicly traded companies. Light-colored lines depict individual medications, and thicker lines represent the weighted mean across the class. Individual lines were not weighted by utilization in the figure, so individual lines do not necessarily sum to the class average, which is a weighted mean, as explained in the Methods section. Net prices are net of all concessions made by manufacturers, including rebates, coupon cards, 340B discounts, prompt pay discounts, return provisions, and any other deductions accounted for in the reporting of net sales. B, Mean discounts in Medicaid and other payers from 2007 to 2018. Discounts are calculated as (list price − net price)/list price. Some individual drugs had values that exceeded the axis limits, including observations for increases in list prices of more than 1000% (arrows).

Figure 3.. Changes in List Prices, Net Prices, and Discounts for Noninsulin Antidiabetics, Tumor Necrosis Factor (TNF) Inhibitors, and Antineoplastic Agents

A, Changes from 2007 to 2018 in list and net prices for branded noninsulin antidiabetics (left), TNF inhibitors (middle), and antineoplastic agents (right) that were available in January 2007 and for which US sales were reported by publicly traded companies. Light-colored lines depict individual medications, and thicker lines represent the weighted mean across the class. Individual lines were not weighted by utilization in the figure, so individual lines do not necessarily sum to the class average, which is a weighted mean, as explained in the Methods section. Net prices are net of all concessions made by manufacturers, including rebates, coupon cards, 340B discounts, prompt pay discounts, return provisions, and any other deductions accounted for in the reporting of net sales. B, Mean discounts in Medicaid and other payers. Discounts are calculated as (list price − net price)/list price. Some individual drugs had values that exceeded the axis limits, including observations for increases in list prices of more than 1000% (arrows).

Figure 4.. Changes in List Prices, Net Prices, and Discounts for Single-Source and Multisource Drugs

A, Changes from 2007 to 2018 in list and net prices for single-source (left) and multisource (right) drugs that were available in January 2007 and for which US sales were reported by publicly traded companies. Net prices are net of all concessions made by manufacturers, including rebates, coupon cards, 340B discounts, prompt pay discounts, return provisions, and any other deductions accounted for in the reporting of net sales. B, Mean discounts in Medicaid and other payers. Discounts are calculated as (list price − net price)/list price.