The 5% · United States · Brand drugs

Why US brand drugs are ~4×

In the US, nobody bargains as a country. Each PBM takes a rebate off a high list. Until the Inflation Reduction Act, Medicare was not allowed to negotiate. Other countries set one price. The manufacturer takes it or does not sell.

PBM list + 340B spread

How it works

Until the Inflation Reduction Act, Medicare was forbidden to negotiate. Private PBMs take rebates off a list that never had a national ceiling. 340B hospitals buy cheap and bill the job plan near ASP-plus. Site of care is a second markup on the same vial.

Why it holds

The US is the residual profit pool for originator drugs. List stays high because nobody bargains as a country. Even after confidential rebates, net brands stay more than 3× other OECD. Unbranded generics go the other way — the US is often cheaper. The 5% buy the brands.

The invoices

SKUUnited StatesOECD peers
Brand originators vs OECDsourced4.22×1.00×
All drugs vs OECDsourced2.78×1.00×
France brands (RAND)sourced$1.0022¢

See RAND drugs, 340B. 30-day list prices: CMS 2023, Inflation Reduction Act round 1.

Twenty brands — US sticker vs OECD

Ranked by the US number. 30-day list is CMS 2023 (Inflation Reduction Act round 1). Infusion doses are our hospital commercial bill. OECD column is US list ÷ 4.22 (RAND brand originators). Gross list, not rebates. Even after a US rebate haircut, RAND says brands stay more than 3×.

DrugUnited StatesOECD peersOn the US $
Keytruda (pembrolizumab)hospital dosemodeled$16,800$3,98124¢
Opdivo (nivolumab)hospital dosemodeled$15,000$3,55524¢
Alteplase (tPA) stroke dosehospital kitmodeled$15,000$3,55524¢
Imbruvica (ibrutinib)30-day listsourced$14,934$3,53924¢
Stelara (ustekinumab)30-day listsourced$13,836$3,27924¢
Herceptin-class (trastuzumab)hospital dosemodeled$9,200$2,18024¢
Neulasta-class (pegfilgrastim)hospital dosemodeled$8,900$2,10924¢
Avastin-class (bevacizumab)hospital dosemodeled$8,100$1,91924¢
Enbrel (etanercept)30-day listsourced$7,106$1,68424¢
Rituximab biosimilarhospital dosemodeled$6,800$1,61124¢
Remdesivir coursehospital coursemodeled$4,200$99524¢
Humira-class (adalimumab) clinicclinic syringemodeled$2,400$56924¢
Ozempic (semaglutide)30-day listmodeled$969$23024¢
Entresto (sacubitril/valsartan)30-day listsourced$628$14924¢
Jardiance (empagliflozin)30-day listsourced$573$13624¢
Farxiga (dapagliflozin)30-day listsourced$556$13224¢
Januvia (sitagliptin)30-day listsourced$527$12524¢
Eliquis (apixaban)30-day listsourced$521$12324¢
Xarelto (rivaroxaban)30-day listsourced$517$12324¢
NovoLog / Fiasp (insulin)30-day listsourced$495$11724¢

Also: Why United States hospital prices · Who bargains with whom · Bargaining chips · The rulebook · Problems / solutions · National debt · Drug voices · Back to The 5%