Pharmacy Markups. Key Themes from the Interviews. Louis Thériault Vice-President, Industry Strategy and Public Policy The Conference Board of Canada

Transcription

1 Pharmacy Markups Key Themes from the Interviews Louis Thériault Vice-President, Industry Strategy and Public Policy The Conference Board of Canada April 26, 2017 Toronto, Ontario conferenceboard.ca

2 Background What we looked at Primer on pharmacy markups to improve our understanding and stimulate discussion. Shed light on what pharmacy markups are, their rationale, how they are determined and differ across Canada, associated challenges and key themes. Our approach consisted of a brief literature review and interviews with experts from pharmacy, wholesale, government, academia, NGO, and insurance. 2

3 Background Considerations Interviews were run under a strict non-attribution clause. This ensured views could be shared freely. This research is not comprehensive, but seeks to provide avenues for further discussion and research. 3

4 Pharmacy Markup Origins Pharmacy markups were established to covering a pharmacy s distribution and inventory carrying costs; not as a profit generator. Markups used to offset costs of dealing with multiple manufacturers. Today, most drugs are delivered through wholesale. This means lower inventory costs but also a transferal of costs to be paid to a wholesaler. Terms such as markup and upcharge are at times used interchangeably Others use them to exclusively refer to one thing. 4

5 Prescription Drug Cost Chain Pharmacy markup and dispensing fees are components of a complex cost chain. Some costs are visible to customers; others are not. It is difficult and potentially misleading to consider pharmacy markups in isolation from other components 5

6 Simplified Example An Ontario resident covered under the Ontario Benefit Program requires a $50 drug. Government regulations stipulate a 8% markup cap (6% for high-cost drugs). The markup would be $50*.08, or $4, with a permissible dispensing of $8.80, which means the pharmacy gets $12.80 to cover its various costs of doing business. Note that if the drug is branded, the pharmacy uses part of the $12.80 to pay the wholesaler an upcharge, which affects the pharmacy s gross profit. This is important to remember when it involves high-cost drugs (e.g. biologics). 6

7 Layers of Complexity Why is it so difficult to analyze markups across Canada? Different places: provincial legislation on caps (if any) Different payers: public, private, cash Different drugs: generics and branded (biologics) Comparing pharmacy markups across all of Canada is like comparing markups across all of Europe. 7

8 Variance in Public Drug Plans 8

9 Private Drug Plans Private plans traditionally show more variation and have less visibility and understanding of the cost chain for drugs Typically resulting in higher markups Although private insurance pays for roughly 1/3 of overall drug costs Traditionally has little role in trying to contain costs. Because of Administrative Services Only (ASO) arrangements in large companies, which means that the employer pays drug costs dollar for dollar, private plans increasingly scrutinize high-cost drugs. 9

10 Explaining the Cost Focus 10

11 Effects Increase of high-cost drugs and related media attention has had the knock-on effect of scrutiny on markups. Going forward, biologics and other high-cost drugs will drive an increased scrutiny through health technology assessments of what ends up on provincial formularies. This may lead to restrictions and more caps, thereby possibly jeopardizing viability and accessibility of complex drug therapies that require specialized patient services. 11

12 What s in a Markup? Interviews showed disagreement between those who believe markups need to reflect growing incurred costs of complex drug requirements (transportation, infrastructure) And those who believe that regional discrepancies, higher markups in private plans, and technological advances justify scrutinizing/restricting markups. Expressing markups as a percentage reflects a time when prescription drugs showed neither the range in costs, nor the volume, nor the patient service complexity of today. There is a need to differentiate. 12

13 Common Themes from the Interview 1. A need to communicate the costs that a pharmacy markup covers and how it is part of a larger supply chain. 2. Caps are but one of several options that can help drive down drug costs, many of which remain underexplored. 3. Media coverage on markups has been too focused on a small segment of extremely high-cost drugs. 4. A race to the bottom on costs may affect the overall robustness of the supply chain and affect accessibility. 13

14 Future Research Possible knock-on effects of provincial mark-up regulation? How does the system shift costs around? Repercussions of lower markup caps on drug supply chain? Longer-term sustainability in an era of spiraling costs? 14

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