Virginia Health Information released its Prescription Drug Pricing Report. The report was created under Virginia law § 32.1-23.4, as further set forth in 12VAC5-219 to increase prescription drug pricing transparency within Virginia and determine drivers of large price increases within the broader supply chain. Data was required to be submitted by health benefit plans, pharmacy benefits managers (PBMs), and drug manufactures on select drugs with high prices, high fill volumes or large cost increases.
All organizations submitted files through a standardized web tool specifically created for the program. Filings were validated and later combined with data from the Virginia All Payer Claims Database (APCD), as well as wholesale pricing data (MediSpan) and pharmacy purchase cost data (NADAC) to provide more a comprehensive view on differences in drug prices throughout the supply chain.
Major findings include:
- The price paid by insurance companies and pharmacies was often less than the suggested Wholesale Acquisition Cost (WAC) for a given drug.
- The 25 drugs with the highest combined insurance company and patient spending accounted for nearly 1/3rd of overall prescription drug spending for individuals with commercial coverage (APCD).
- Of the $110 million in reported rebates for high-cost drugs, only about $2 million was reported as being passed on to the health benefit plan enrollee at the point of sale.
- The Highest WAC increase recorded for the year was for Glipizide (range from 11-25%). No other drugs reported an increase in WAC in excess of 10%.
- § 32.1-23.4. Prescription drug price transparency; civil penalty
- 12VAC5-219. Prescription Drug Price Transparency Regulation (adding 12VAC5-219-10 through 12VAC5-219-140).