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.
Authors
- Anna Hung (ORCID: https://orcid.org/0000-0002-0730-431X)
- Sean Dickson
Institutions
- Duke University (US)
- America's Health Insurance Plans (US)
- Durham VA Health Care System (US)
- Duke Institute for Health Innovation (US)
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