A primer on prescription drug pricing benchmarks in the United States

The price of a prescription drug can be difficult to determine in the United States. Pricing benchmarks are reference points used to determine acquisition costs as drugs are physically moved through the supply chain, to reimburse pharmacies, to calculate rebates, and to determine patient payments. Public health insurance programs, including Medicare and Medicaid, leverage different pricing benchmarks to pay for drugs for their beneficiaries, and the same drug can vary in price by program. The goal of this primer is to explain the most commonly used drug pricing benchmarks and their current contexts for use.

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Publication Details

Journal
Journal of Managed Care & Specialty Pharmacy
Published
2025-11-26
DOI
https://doi.org/10.18553/jmcp.2025.31.12.1326
Primary Topic
Pharmaceutical Economics and Policy
Type
article
Field-Weighted Citation Impact
0.00
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article

A primer on prescription drug pricing benchmarks in the United States

Anna Hung, Sean Dickson
Journal of Managed Care & Specialty Pharmacy
Pharmaceutical Economics and Policy
article

A primer on prescription drug pricing benchmarks in the United States

Anna Hung, Sean Dickson
article en

Abstract

The price of a prescription drug can be difficult to determine in the United States. Pricing benchmarks are reference points used to determine acquisition costs as drugs are physically moved through the supply chain, to reimburse pharmacies, to calculate rebates, and to determine patient payments. Public health insurance programs, including Medicare and Medicaid, leverage different pricing benchmarks to pay for drugs for their beneficiaries, and the same drug can vary in price by program. The goal of this primer is to explain the most commonly used drug pricing benchmarks and their current contexts for use.

Journal of Managed Care & Specialty PharmacyVol. 31(12)
Duke University (US), America's Health Insurance Plans (US), Durham VA Health Care System (US), Duke Institute for Health Innovation (US)
Openalex Percentile: Top 56%
Pharmaceutical Economics and Policy
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