This week, the RAND Corporation issued a new report highlighting that US list prices on insulin are 8.1 times higher than the average prices paid in other developed nations. However, the RAND investigators noted that had rebates and discounts been factored into the analysis, the US prices have been about 4 times higher. With so much controversy and politically charged arguments around drug pricing, it is imperative for researchers to use net prices in their analyses and when that is not possible, the limitation should be noted as the RAND team did.
To its credit, ICER uses estimated net pricing in both its value assessments and unsupported price increase reports. However, patients can still be exposed to list prices when they are either uninsured or paying a percentage-based co-insurance. In fact, ICER’s new “Cornerstones for Fair Access” white paper urges insurers to stop basing copay percentages off of unnegotiated list prices. In sum, discussions around the fairness of a drug’s price should remain focused on the net price, after all discounts and rebates are factored in.