OBJECTIVES: With US prescription drug costs rising each year, we describe and quantify 2011-2021 trends in the distributions of commercial and Medicare prescription claim payments, providing insight into the potential financial impact on the drug channel, particularly, retail pharmacies.

METHODS: 2011-2021 pharmacy claim files from the Merative™ MarketScan® Commercial and Medicare Databases were accessed. We included brand and generic prescription claims with positive payment, days supply, and quantity values. Mean, 10^th, 25^th, 50^th, 75^th, and 90^th percentile values were calculated for total (plan + patient) claim payments for each year and reported separately for brand, generic, retail pharmacy, and mail pharmacy categories. Mean days supply was compared between retail and mail pharmacy categories.

RESULTS: A total of 2.55 billion commercial and 588 million Medicare prescription claims were included in the analysis. Mean commercial and Medicare claim payments increased between 2011 and 2021: commercial retail—$72.04 to $143.08; commercial mail—$257.67 to $614.37; Medicare retail—$68.99 to $140.99; Medicare mail—$173.23 to $244.38. However, median commercial and Medicare claim payments decreased: commercial retail—$18.93 to $10.97; commercial mail—$68.80 to $20.00; Medicare retail—$17.35 to $12.88; Medicare mail—$43.58 to $18.77. Generic drug claim payments remained flat or decreased over the 11-year period, while high brand drug claim payments represented the segment with the largest payment growth. Generic drugs accounted for over 88% of total retail pharmacy claims in 2021. Mean days supply increased for retail pharmacy claims but remained relatively stable for mail pharmacy claims.

CONCLUSIONS: The distributions for prescription drug claim payments in the US are highly skewed, characterized by growth in mean claim payments and reductions in median payments. Results indicate that the downward trend on median payment per claim relative to growing dispensing costs over time negatively impacts the economics of dispensing prescriptions, particularly within the retail pharmacy channel.