Presentation (CTI)

OBJECTIVES: List prices for specialty drugs - high-cost therapies often requiring particular handling, storage and physician administration - are at the center of policy discussions. These prices are important because they influence patients’ out-of-pocket costs, which are typically based on list, rather than net prices negotiated by payers. Understanding the factors influencing negotiated rebates is critical for informing policy debates around drug affordability and patient access.
METHODS: We analyzed rebates, defined as the percentage difference between list and net prices, for 161 high profile specialty drugs using pricing information in the SSR Health US Brand Rx Net Pricing Tool in 2023. We conducted a multivariable regression analysis to identify factors influencing rebate size, including drug type (e.g., biosimilars, originators, oncology treatments, orphan drugs), route of administration (self-administered vs. physician-administered), number of indications, level of competition, and time since FDA approval.
RESULTS: The study found substantial variation in rebates across drug characteristics (median of 27%, IQR 16-53%). Biosimilars and originator drugs had the highest and most variable rebates (median of 71%, IQR 53-79%), while cancer treatments and orphan drugs had the lowest (medians of 19% and 23%, respectively) and least variable rebates (IQR of 12-28% and 14-29%, respectively). In the multivariable analysis, drugs with more competition, physician-administered drugs, drugs with multiple indications, and older drugs tended to have higher rebates.
CONCLUSIONS: The substantial variation in rebates underscores the complexity of specialty drug pricing. Addressing prescription drug affordability and patient access requires greater transparency in rebate practices. Further research is needed to better understand the drivers of these variations and to identify potential policy interventions that can mitigate the financial burden on both patients and payers.