Underscoring the opaque and confusing nature of pharmaceutical pricing, Amgen announced long-awaited discounts for its biosimilar version of Humira — the world’s best-selling medicine — and the numbers suggest the biggest winners may be health insurers and others in the supply chain, but not patients.
Here’s why: The drug company will offer its medication, called Amjevita, at two different discounts — 5% and 55% — off the roughly $80,000 wholesale, or list, price. The maneuver reflects the behind-the-scenes negotiations that occur between pharmaceutical companies and the pharmacy benefit managers, or PBMs, that create formularies, or lists of medicines for which insurance coverage is provided.
To win favorable placement, drug companies typically offer rebates, which the PBMs are supposed to pass along to health plans. But a big discount off the wholesale price means less money for PBMs to pass along to insurers while also capturing fees. So while a 55% discount sounds impressive, there is less incentive for a PBM to bite. In other words, the 5% discount is likely to be more popular with payers.
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