Monday, January 12, 2009

Who Pays for Prescription Drugs?

If you’re like me, you spent Sunday afternoon drinking beer, watching the Eagles trounce the Giants (whoo-hooo!), and poring over the latest U.S. National Health Expenditure data from CMS. (For the record, scrutinizing health expenditure data is a lot more fun when done in combination with football and beer, but that’s a subject for another post.)

Anyway, as widely reported last week, U.S. spending on outpatient prescription drugs grew by only 4.9 percent in 2007, which was below overall health care spending growth of 6.1 percent.

Here are three links for your reading pleasure, listed in increasing order of policy wonkiness:

CMS economists attribute the 2007 slowdown to three major factors:

  1. A generic dispensing rate of 67 percent in 2007, up from 63 percent in 2006 and 60 percent in 2005.
  2. Safety issues – The FDA issued 68 “black box” warnings in 2007 compared to 58 in 2006 and 21 in 2003.
  3. Part D spending, which declined following the one-time growth effect of adding the benefit in 2006

I was especially interested to see that public funds paid for 36 percent of total retail drug spending in 2007. The majority of public funds were associated with major CMS programs: Medicare, Medicaid, and State Children’s Health Insurance Program (SCHIP).

During halftime (with Eagles 10, Giants 8), I created the following chart to show how payments for prescription drugs (share of dollars) has changed during my lifetime.

Pretty amazing, isn’t it? Payment for drugs by private health insurance peaked in 2001 at 50 percent. Since then, public funds have been crowding out both public and out-of-pocket payments. CMS has not updated their forecasts yet, but public funds will probably pay more for prescriptions than private insurance within ten years.

So, how much money do pharmacies make from each of these payers?

Stay tuned later this week – the answer will surprise you!