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. 2023 Dec 26;330(24):2390-2392.
doi: 10.1001/jama.2023.21481.

Reimbursement to Pharmacies for Generic Drugs by Medicare Part D Sponsors

Inmaculada Hernandez  1 , Nico Gabriel  1 , Anna Kaltenboeck  2 , Cristina Boccuti  3 , Ryan N Hansen  4 , Sean D Sullivan  4
Affiliations

Reimbursement to Pharmacies for Generic Drugs by Medicare Part D Sponsors

Inmaculada Hernandez et al. JAMA. .
No abstract available

Plain language summary

This study evaluates whether organizations that offer Medicare Part D plans (referred to as Part D sponsors) overpay pharmacies for generic drugs.

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Conflict of interest statement

Conflict of Interest Disclosures: Ms Kaltenboeck reports being employed by ATI Advisory, which receives payment for consulting services from private entities; ATI Advisory received funding from West Health Institute during the conduct of this study. Dr Hansen reported being a partner at Kelley-Ross Pharmacy Group, which operates independent community pharmacies, and being a board member of the Compliant Pharmacy Alliance, an independent community pharmacy group purchasing organization. No other disclosures were reported.

Figures

Figure.
Figure.. Reimbursement to Cost Ratio in Quarter 1, 2021, by Generic Drug and Part D Sponsor
The reimbursement to cost ratio compares the amount that Part D plans reimbursed pharmacies for generic drugs (numerators) with generic acquisition costs (denominators). Orange lines and whiskers represent the mean and 95% CI across 50 generic products. Data are shown separately for the top 6 Part D sponsors, or the largest 6 companies that offer Medicare plans that exclusively cover outpatient prescription drugs. Part D sponsor means were calculated by aggregating results for each prescription drug plan offered by the sponsor and using relative enrollment as a weight.
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References

    1. Sunshine in the black box of pharmacy benefits management: Florida Medicaid pharmacy claims analysis. January 27, 2020. Accessed March 3, 2023. https://ncpa.co/pdf/florida-3aa-medicaid-pharmacy-analysis.pdf
    1. Senate Finance Committee . A bipartisan framework for reducing prescription drug costs by modernizing the supply chain and ensuring meaningful relief at the pharmacy counter. April 20, 2023. Accessed June 15, 2023. https://www.finance.senate.gov/imo/media/doc/042023%20SFC%20Framework%20...
    1. Prescription drug plan formulary, pharmacy network, and pricing information files for order. Centers for Medicare & Medicaid Services. Accessed March 21, 2023. https://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order...
    1. Maine Health Data Organization. Prescription drug transparency report. December 14, 2022. Accessed March 20, 2023. https://mhdo.maine.gov/_pdf/MHDO%20Rx%20Transparency%20Report_221213.pdf
    1. Centers for Medicare & Medicaid Services . Medicare Advantage/Part D contract and enrollment data. Accessed March 21, 2023. https://www.cms.gov/research-statistics-data-and-systems/statistics-tren...

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