5 ms·

Thanks. As I recall, AWP for some generics was way more that 100 times actual prices paid by pharmacies. And even WAC for some was on the order of 100 times act

Thanks. As I recall, AWP for some generics was way more that 100 times actual prices paid by pharmacies. And even WAC for some was on the order of 100 times actual prices paid by pharmacies. Generic manufacturers were actually competing on spreads for AWP and WAC vs actual prices. Because, when there are several manufacturers, actual generic prices approach marginal cost of production. I had no clue that Medicare was still using AWP and WAC for pharmacy-dispensed drugs. That's too stupid for words. But it seems that Medicaid has figured it out.

refurb 8y ago
It's complicated, but quite fascinating to see how we got to where we are today. You are correct that some drugs were being discounted 95%+ below AWP and the entire spread was being pocketed by pharmacies. For a very fascinating story, google Ven-a-Care Pharmacy.[1] Their entire business model turned in suing drug manufacturers on behalf of the gov't under the False Claims Act. Since they were a pharmacy, they had visibility into both the prices that drug manufacturers charged and the reimbursement the gov't paid. I believe most of their cases were related to the drug manufacturers not correctly reporting their prices to the gov't, thus causes Medicaid and Medicare to overpay. Last I heard they had collected over $300M in whistleblower settlements. [1]http://www.abajournal.com/news/article/repeat_whistleblowers_reap_millions_of_dollars_in_false_claims_suits/ http://www.abajournal.com/news/article/repeat_whistleblowers...
- mirimir 8y ago
  Wow. What I know comes from a "you won't believe this!" conversation in some hotel bar at a conference, some years ago.