AMCP 2022: Digital Therapeutics and the Medical, Pharmacy Benefit: Which Side Should They Go On?

AMCP CEO Susan Cantrell stresses how collaboration is key in addressing challenges such as high drug prices and healthcare disparities. While there’s no silver bullet, solutions such as tailored population benefit design and value-based contracting can play an important role in making a difference for ordinary Americans looking for affordable access to prescriptions.

Hernandez co-authored a June study in the Journal of Managed Care & Specialty Pharmacy (JMCP) on price benchmarks for selected drugs and their therapeutic alternatives, which concluded different negotiation scenarios for the first 10 drugs. If a drug has a therapeutic alternative, that likely guided the initial price offer from the CMS.

Because most prescription drugs selected for negotiation are highly rebated and discounted—prior to the federal government negotiations—comparisons of MFPs with list prices are somewhat misleading. Many of the ten drugs chosen already had significant rebates, in some cases as high as 68% off of the wholesale acquisition cost.