Drug Channels: Follow the Dollar Math: How Much Do Pharmacies, Wholesalers, and PBMs Make From a Prescription?

August 8, 2017

Yesterday,The Wall Street Journal published an intriguing article by Jonathan Rockoff titled Behind the Push to Keep Higher-Priced EpiPen in Consumers’ Hands.

The article includes a graphic attributed to me (cited as Pembroke Consulting). It shows that the drug channel—pharmacy benefit managers (PBMs), wholesalers, and pharmacies—receive more than $37 in gross profit for a brand-name drug with a $300 list price. PBMs capture about half of this amount.The WSJ article doesn’t describe how I arrived at the figures. But now you, Drug Channels reader, will get the inside scoop.

Source: Drug Channels: Follow the Dollar Math: How Much Do Pharmacies, Wholesalers, and PBMs Make From a Prescription?

Advertisements

NIHCM – The Concentration of U.S. Health Care Spending

July 19, 2017

The Concentration of U.S. Health Care Spending

Source: NIHCM – The Concentration of U.S. Health Care Spending


Mortality and morbidity in the 21st century | Brookings Institution

March 23, 2017

The combined effect means that mortality rates of whites with no more than a high school degree, which were around 30 percent lower than mortality rates of blacks in 1999, grew to be 30 percent higher than blacks by 2015.

Source: Mortality and morbidity in the 21st century | Brookings Institution


Experienced Inequality and Preferences for Redistribution by Christopher Roth, Johannes Wohlfart :: SSRN

February 12, 2017

We examine in how far people’s experiences of income inequality affect their preferences for redistribution. We use several large nationally representative datasets to provide evidence that people who have experienced more inequality while growing up are less in favor of redistribution, after controlling for income, demographics, unemployment experiences and current macro-economic conditions. They are also less likely to consider the prevailing distribution of incomes to be unfair, suggesting that inequality experiences affect the reference point about what is a fair division of overall income. Finally, we conduct an experiment to show that individuals randomly exposed to environments promoting inequality in the experience stage of the experiment redistribute less in a subsequent behavioral measure.

Source: Experienced Inequality and Preferences for Redistribution by Christopher Roth, Johannes Wohlfart :: SSRN


Savings Medicare Beneficiaries Need for Health Expenses: Some Couples Could Need as Much as $350,000 by Paul Fronstin, Jack VanDerhei :: SSRN

February 9, 2017

This paper examines the amount of savings Medicare beneficiaries are projected to need to cover program deductibles, premiums and other health expenses in retirement. For the purposes of this study, health expenses include premiums for Medicare Parts B and D, premiums for Medigap Plan F, and out-of-pocket spending for outpatient prescription drugs. Data come from a variety of sources and are used in a Monte Carlo simulation model that simulates 100,000 observations, allowing for the uncertainty related to individual mortality and rates of return on assets in retirement.

  • In 2016, a 65-year-old man would need $72,000 in savings and a 65-year-old woman would need $93,000 if each had a goal of having a 50 percent chance of having enough savings to cover health care expenses in retirement.
  • If they wanted a 90 percent chance of having enough savings, the man would need $127,000 and the woman would need $143,000.
  • A couple with median prescription drug expenses would need $165,000 if they had a goal of having a 50 percent chance of having enough savings to cover health care expenses in retirement. If they wanted a 90 percent chance of having enough savings, they would need $265,000.
  • For a couple with drug expenses at the 90th percentile throughout retirement who wanted a 90 percent chance of having enough money saved for health care expenses in retirement by age 65, targeted savings would be $349,000 in 2016.
  • From 2015 to 2016, projected savings targets increased between 0 percent and 6 percent. In contrast, savings targets declined between 2011 and 2014, but then they increased from 2014 to 2015 as well. Despite the increase in savings targets since 2014, the 2016 savings targets continue to be lower than they were in 2012 almost across the board. It is important to note that many individuals are likely to need more than the amounts cited in this report.

This analysis does not factor in the savings needed to cover long-term care expenses and other expenses not covered by Medicare, nor does it take into account the fact that many individuals retire prior to becoming eligible for Medicare. However, some workers will need to save less than what is reported if they choose to work past age 65, thereby postponing enrollment in Medicare Parts B and D if they receive health benefits as active workers.

Source: Savings Medicare Beneficiaries Need for Health Expenses: Some Couples Could Need as Much as $350,000 by Paul Fronstin, Jack VanDerhei :: SSRN


Longitudinal Evidence for a Midlife Nadir in Human Well‐Being: Results from Four Data Sets by Terence Chai Cheng, Andrew J. Oswald :: SSRN

February 8, 2017

There is a large amount of cross‐sectional evidence for a midlife low in the life cycle of human happiness and well‐being (a ‘U shape’). Yet no genuinely longitudinal inquiry has uncovered evidence for a U‐shaped pattern. Thus, some researchers believe the U is a statistical artefact. We re‐examine this fundamental cross‐disciplinary question. We suggest a new test. Drawing on four data sets, and only within‐person changes in well‐being, we document powerful support for a U shape in longitudinal data (without the need for formal regression equations). The article’s methodological contribution is to use the first‐derivative properties of a well‐being equation.

Source: Longitudinal Evidence for a Midlife Nadir in Human Well‐Being: Results from Four Data Sets by Terence Chai Cheng, Andrew J. Oswald :: SSRN


Health Insurance Without Single Crossing: Why Healthy People Have High Coverage by Jan Boone, Christoph Schottmüller :: SSRN

February 8, 2017

Standard insurance models predict that people with high risks have high insurance coverage. It is empirically documented that people with high income have lower health risks and are better insured. We show that income differences between risk types lead to a violation of single crossing in an insurance model where people choose treatment intensity. We analyse different market structures and show the following: if insurers have market power, the violation of single crossing caused by income differences and endogenous treatment choice can explain the empirically observed outcome. Our results do not rely on differences in risk aversion between types.

Source: Health Insurance Without Single Crossing: Why Healthy People Have High Coverage by Jan Boone, Christoph Schottmüller :: SSRN