Solve/understand this US Healthcare Drug Pricing problem: Assumptions: 1. Manufacturer List Price is $3.25/tablet for Brand E,

Solve/understand this US Healthcare Drug Pricing problem:

  

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Assumptions: 1. Manufacturer List Price is $3.25/tablet for Brand E, 60 tablets/bottle 2. Tablet is taken twice/day; Product is on Tier 2 for Managed Care/PBM and Tier 3 for Medicare 3. Co-Pays for Managed Care/PBM are $5 Tier 1, $25 Tier 2, $40 Tier 3, Coinsurance 25% Tier 4 4. Co-Pays for Medicare are $3 Tier 1, $15 Tier 2, $35 Tier 3, Coinsurance 20% Tier 4 5. Medicare Part D Plans gets a 30% rebate for Tier 2; 20% for Tier 3; 0% for Tier 4 when not in the donut hole a. Manufacturers provide a 50% discount on brand-name drugs when in the donut hole PHS Hospital is given highest price that is still nominal Cash Paying customer pays AWP +5% Wholesaler pays list price after 30 days 9. Managed Care and VA/Military are considered equivalent plans 10. Medicaid & FSS has no CPI penalty 11. MediCal, California controlled Medicaid gets a 10% supplemental rebate for Tier 2 and 3 12. Managed Care/PBM reimburses brand to pharmacy at AWP -10% 13. Managed Care/PBM gets the following rebate from the manufacturer: 15% rebate for Tier 2 6. 7. 8. a. b. C. 5% rebate for Tier 3 0% rebate for Tier 4 Assumptions: 1. Manufacturer List Price is $3.25/tablet for Brand E, 60 tablets/bottle 2. Tablet is taken twice/day; Product is on Tier 2 for Managed Care/PBM and Tier 3 for Medicare 3. Co-Pays for Managed Care/PBM are $5 Tier 1, $25 Tier 2, $40 Tier 3, Coinsurance 25% Tier 4 4. Co-Pays for Medicare are $3 Tier 1, $15 Tier 2, $35 Tier 3, Coinsurance 20% Tier 4 5. Medicare Part D Plans gets a 30% rebate for Tier 2; 20% for Tier 3; 0% for Tier 4 when not in the donut hole a. Manufacturers provide a 50% discount on brand-name drugs when in the donut hole PHS Hospital is given highest price that is still nominal Cash Paying customer pays AWP +5% Wholesaler pays list price after 30 days 9. Managed Care and VA/Military are considered equivalent plans 10. Medicaid & FSS has no CPI penalty 11. MediCal, California controlled Medicaid gets a 10% supplemental rebate for Tier 2 and 3 12. Managed Care/PBM reimburses brand to pharmacy at AWP -10% 13. Managed Care/PBM gets the following rebate from the manufacturer: 15% rebate for Tier 2 6. 7. 8. a. b. C. 5% rebate for Tier 3 0% rebate for Tier 4

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