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Medicare Part D Payments for Generic Imatinib

Point-of-sale prices for generic imatinib are substantially higher than the pharmacy acquisition costs from 2017 to 2023, a study of Medicare Part D beneficiaries shows. Noting that it is unclear whether the pharmacy, the pharmacy benefits manager (PBM), or the Part D plan sponsor reaps the windfall from this arrangement, the authors conclude: “Government efforts are underway to investigate the prescription drug supply chain and PBM practices and financial flow. The gap between generic imatinib point-of-sale prices and average pharmacy acquisition costs supports these efforts to evaluate spending across PBMs, health plans, and pharmacies to avoid overpayment for medications covered under Medicare Part D.”

The generic imatinib products began entering the U.S. market in 2016; 13 generic equivalents have been approved. Data for all Medicare Part D plan, contract, and formulary records in each calendar year showed the following: “A total of 33,022 unique plan contract and formulary observations were included in the analysis.… Between 2017 and 2023, pharmacy acquisition costs for generic imatinib declined 98.8%, from $5310 to $59 per fill. Over the same period, the median Medicare point-of-sale price declined 81.4%, from $8618 to $1602. The 25th percentile of prices declined 94.4%, from $8370 to $469, and the 75th percentile of prices declined 38.5%, from $8890 to $5466.

“Although point-of-sale prices for generic imatinib declined over time, the median markup percentage increased from 62% of acquisition costs (median point-of-sale price of $8618 vs $5310 in mean acquisition costs) in 2017 to 2615% (median point-of-sale price of $1602 vs $59 in mean acquisition costs) by 2023. Despite pharmacy mean acquisition costs of $59 per fill in 2023, Medicare beneficiaries would pay an estimated $80 to $400 out-of-pocket per fill at the median point-of-sale price depending on whether they are in the gap or catastrophic Medicare benefit phase.”

Editorial: “By formalizing the framework for the current market in which low-cost generic drugs make up 90% of prescriptions for US patients, the Hatch-Waxman Act has been perhaps the most important piece of pharmaceutical legislation in the past 40 years,” editorialists write. “As numerous other specialty drugs are expected to reach the ends of their market exclusivity periods in the next 5 to 10 years, more attention from legislators or regulators may be needed to ensure that patients can continue to benefit from the timely availability of low-cost generic drugs.”

Source: JAMA Internal Medicine