The 2017 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers

by Adam J. Fein, Ph.D.
(downloadable PDF file; Released February 2017)

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The 2017 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers (known in our previous editions as The Economic Report on Retail, Mail, and Specialty Pharmacies) remains the most comprehensive, fact-based analysis of the evolving drug channels within the U.S. healthcare system.

It’s your ultimate guide to the complex web of interactions within the U.S. prescription distribution and reimbursement system. This unique resource will benefit pharmaceutical manufacturers, wholesalers, pharmacists, pharmacy owners, hospital executives, buyers, benefit managers, managed care executives, policy analysts, investors, consultants—anyone who wants to understand and benefit from this ever-changing industry.

The report was researched and written by Adam J. Fein, Ph.D., one of the world’s leading experts on the industry and author of the influential Drug Channels website. It synthesizes a wealth of statistical data, research studies, financial information, and his unique business consulting experience into a definitive, nonpartisan resource.

The new title for our eighth edition reflects report’s the increasingly broad scope. It integrates information about pharmacy dispensing channels, third-party payers, pharmacy benefit managers (PBMs), patients’ financial contributions, and drug wholesalers. The revised title also acknowledges that 6 of the 15 largest U.S. pharmacies are owned and operated by PBMs and health plans.

There are many significant updates to the 2017 report. Download a free report overview for more details.

The chapters are self-contained and do not need to be read in order. We include extensive internal references to help you navigate the entire document and customize it to your specific needs. (These references are clickable hyperlinks in the PDF document.) There are also more than 400 endnotes, most of which have hyperlinks to original source materials.

Please note that purchase of The 2017 Economic Report U.S. Pharmacies and Pharmacy Benefit Managersindicates agreement with the terms and conditions of the End User License Agreement (EULA). License terms, purchaser’s name/email, and a unique transaction ID will be added to the secure PDF file upon checkout. You must purchase a Department/Team or Corporate License if you want to share the report with other people in your company. Upon request, we will refund duplicate purchases of a Corporate License from the same organization.

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LICENSE TERMS

Pembroke Consulting, Inc., d/b/a Drug Channels Institute, grants to Purchaser, and Purchaser hereby accepts, a limited, terminable, revocable, nontransferable, nonexclusive, nonsublicenseable license to access and use The 2017 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers only in accordance with the End User License Agreement. License terms, purchaser’s name/email, and a unique transaction ID will be added to the secure PDF file upon checkout. We offer three License Options:

  • Single User License: This license allows for use of this report by one individual person. This person may use the report on any computer, and may print out the report, but may not share the report with any other person or persons. Unless a Department/Team License is purchased, a Single User License must be purchased for every person who wishes to use the report within the same organization or enterprise. Buyers who infringe upon these license terms are liable for a Department/Team or Corporate License fee.
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The 2017 Economic Report on U.S. Pharmacies and Pharmacy Benefits Managersis protected by copyright law. Unauthorized reproduction or distribution of this report, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent of the law. This report may be cited in commercial documents with full and appropriate attribution. Nothing in this license is intended to reduce, limit, or restrict any rights arising from fair use under copyright law or other applicable laws.

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TABLE OF CONTENTS

Introduction and Guide to This Report

PREFACE: INDUSTRY TRENDS AND KEY REPORT THEMES

SECTION I: THE U.S. PHARMACY INDUSTRY

Chapter 1: Industry Overview

  • 1.1. Pharmacy Fundamentals
    • 1.1.1. Defining the Practice of Pharmacy
    • 1.1.2. Pharmacies and the Drug Supply Chain Security Act
  • 1.2. The Products That Pharmacies Dispense
    • 1.2.1. Brand vs. Generic Drugs
    • 1.2.2. Traditional vs. Specialty Drugs
    • 1.2.3. Average U.S. Prescription Revenues
    • 1.2.4. Top Traditional Therapy Classes and Average Prescription Costs
    • 1.2.5. Top Specialty Therapy Classes and Average Prescription Costs
  • 1.3. Pharmacy Industry Participants
    • 1.3.1. Pharmacy Dispensing Formats
    • 1.3.2. Differences Among Outpatient Retail Dispensing Formats
    • 1.3.3. Pharmacist Employment and Salaries
  • 1.4. Healthcare and Clinical Services
    • 1.4.1. Retail Clinics
    • 1.4.2. Clinical Services and Medication Therapy Management (MTM)
    • 1.4.3. Immunization

Chapter 2: Pharmacy Industry Market Structure

  • 2.1. Industry Trends
    • 2.1.1. Total and 30-Day Equivalent Prescriptions
    • 2.1.2. Prescription Dispensing Revenues
  • 2.2. National Prescription Dispensing Market Share by Company
  • 2.3. Trends by Dispensing Format
    • 2.3.1. Revenues, Prescriptions, and Number of Pharmacies: 2011 to 2016 Trends
    • 2.3.2. Market Changes in 2016
    • 2.3.3. National Retail Chains
    • 2.3.4. Regional Drugstore Chains
    • 2.3.5. Independent Pharmacies
    • 2.3.6. Mail Pharmacies

Chapter 3: Specialty Drugs and Specialty Pharmacies

  • 3.1. Specialty Pharmacies
    • 3.1.1. Defining Specialty Pharmacy
    • 3.1.2. Clinical and Data Services
    • 3.1.3. Accreditation
  • 3.2. Specialty Pharmacy Market Structure
    • 3.2.1. Specialty Industry Revenues and Number of Specialty Pharmacies
    • 3.2.2. National Market Share for Specialty Dispensing by Company
    • 3.2.3. Mergers & Acquisitions Among Specialty Pharmacies in 2016
  • 3.3. Trends by Specialty Dispensing Format
    • 3.3.1. Overview
    • 3.3.2. Pharmacy Benefit Managers and Health Plans
    • 3.3.3. Independent Specialty Pharmacies
    • 3.3.4. Retail Community Pharmacies
    • 3.3.5. Hospitals and Health Systems
    • 3.3.6. Physician Practices
    • 3.3.7. Pharmaceutical Wholesalers
  • 3.4. Manufacturer Channel Strategies for Specialty Drugs
    • 3.4.1. Manufacturer-Defined Dispensing Networks
    • 3.4.2. Manufacturers’ Distribution Strategies for Specialty Drugs
    • 3.4.3. Specialty Hub Services
  • 3.5. The Outlook for Pharmacy-Dispensed Biosimilars

SECTION II: THIRD-PARTY PAYMENT AND PHARMACY BENEFITS

Chapter 4: Payment and Spending for Prescription Drugs

  • 4.1. U.S. Healthcare Spending
    • 4.1.1. Enrollment in Health Insurance
    • 4.1.2. Prescription Drugs and U.S. Healthcare Spending
  • 4.2. Payer and Spending Trends for 2015
    • 4.2.1. Payment for Outpatient Prescription Drugs in 2015
    • 4.2.2. Trends in Drug Spending for 2015 by Payer
    • 4.2.3. Trends in Drug Spending for 2015: Traditional vs. Specialty
    • 4.2.4. Deconstructing Changes in Cost vs. Utilization
  • 4.3. The Drug Spending Outlook
    • 4.3.1. The Generic Plateau and the Specialty Boom
    • 4.3.2. U.S. Net Drug Spending Projections to 2025
    • 4.3.3. Payment for Outpatient Prescription Drugs in 2025: Baseline Projections
    • 4.3.4. The Impact of Changes to the Affordable Care Act

Chapter 5: Pharmacy Benefit Management

  • 5.1. Overview of Pharmacy Benefit Management
    • 5.1.1. Services for Plan Sponsors
    • 5.1.2. Formulary Development and Management
    • 5.1.3. Utilization Management
  • 5.2. PBM Industry Structure
    • 5.2.1. National Market Share by PBM
    • 5.2.2. Business Strategies of Largest PBMs
  • 5.3. Formulary Rebates
    • 5.3.1. Manufacturer Rebates and Gross-to-Net Pricing
    • 5.3.2. Formulary Exclusions
    • 5.3.3. How Rebates Affect Third-Party Payers
    • 5.3.4. Rebates and Drug Prices
  • 5.4. Relationships Between PBMs and Pharmacies
    • 5.4.1. Pharmacy Participation in PBM Networks
    • 5.4.2. PBM-Pharmacy Negotiations
    • 5.4.3. Pharmacy Services Administration Organizations (PSAOs)
  • 5.5. PBM Compensation by Plan Sponsors
    • 5.5.1. Spread Pricing
    • 5.5.2. Pass-Through Pricing
    • 5.5.3. Evaluation of Spread vs. Pass-Through PBM Compensation

Chapter 6: Consumer Copayments and Coinsurance

  • 6.1. Employer-Sponsored Health Plans
  • 6.2. Health Insurance Marketplace Plans
  • 6.3. Medicare Part D
  • 6.4. Medicaid
  • 6.5. Prescription Drug Deductibles
  • 6.6. Manufacturer Copayment Offset Programs

Chapter 7: Narrow Pharmacy Networks

  • 7.1. Overview of Pharmacy Benefit Network Models
    • 7.1.1. Network Options
    • 7.1.2. The Appeal of Narrow Networks
  • 7.2. Retail Pharmacy Networks
    • 7.2.1. Preferred Retail Networks in Medicare Part D
    • 7.2.2. Narrow Retail Networks in Commercial and Other Plans
    • 7.2.3. Narrow Networks for Maintenance Prescriptions
  • 7.3. Payer-Defined Specialty Dispensing Networks

SECTION III: DRUG CHANNEL ECONOMICS

Chapter 8: Prescription Reimbursement by Third-Party Payers

  • 8.1. The Basics of Prescription Reimbursement
    • 8.1.1. Estimated Acquisition Cost (EAC)
    • 8.1.2. Dispensing Fees
    • 8.1.3. Service and Data Fees
  • 8.2. Reimbursement for Brand-Name and Specialty Prescriptions
    • 8.2.1. Wholesale Acquisition Cost (WAC) and Average Wholesale Price (AWP) List Prices
    • 8.2.3. Average AWP Discounts for Pharmacy Reimbursement
    • 8.2.3. Why Mail Pharmacies Accept Lower Reimbursements
  • 8.3. Reimbursement for Generic Prescriptions
    • 8.3.1. Challenges for List-Price Benchmarks
    • 8.3.2. Maximum Allowable Cost (MAC) Limits
    • 8.3.3. Regulation and Laws Regarding MAC Limits
    • 8.3.4. Medicaid and Federal Upper Limits
  • 8.4. Acquisition Cost Reimbursement
  • 8.5. How Prescription Reimbursement, Formulary Rebates, Consumer Copayments, and PBM Expenses Affect Plan Sponsor Costs

Chapter 9: Relationships with Pharmaceutical Wholesalers

  • 9.1. Overview of Wholesale Drug Channels
    • 9.1.1. Industry Participants
    • 9.1.2. Product Distribution
    • 9.1.3. Financial Intermediation
    • 9.1.4. Influence on Pharmacy Reimbursement
  • 9.2. Wholesalers’ Relationships with Pharmacies
    • 9.2.1. Services for Independent Pharmacies
    • 9.2.2. Wholesale Suppliers to Largest U.S. Pharmacies
  • 9.3. Determinants of Pharmacies’ Acquisition Costs
    • 9.3.1. Cost-Minus Pricing of Brand-Name Drugs to Pharmacies
    • 9.3.2. Sell-Side Margin Trends for Specialty Drugs
    • 9.3.3. Pharmacy Group Purchasing Organizations
    • 9.3.4. Generic Sourcing Relationships Between Wholesalers and Large Pharmacies

Chapter 10: Pharmacy and Prescription Profitability

  • 10.1. Overall Drugstore Gross Margins
    • 10.1.1. Industry Averages
    • 10.1.2. Chain Drugstores
  • 10.2. Pharmacy Per-Prescription Profits
    • 10.2.1. Sources of Per-Prescription Profits
    • 10.2.2. Average Per-Prescription Profits
    • 10.2.3. PBM Per-Prescription Profits from Network and PBM-Owned Pharmacies
    • 10.2.4. The Impact of Brand-Name Inflation on Prescription Profits
    • 10.2.5. Pharmacy Profits with Acquisition Cost-Based Reimbursement
  • 10.3. Profitability for Generic Prescriptions
    • 10.3.1. Lifecycle Profits for Generic Drugs
    • 10.3.2. Generic Price Deflation and Inflation
    • 10.3.3. The Decline of Retail Generic Drug Discount Programs
  • 10.4. Per-Prescription Fees and Payments
    • 10.4.1. DIR Fees in Medicare Part D Networks
    • 10.4.2. Performance-Based Pharmacy Networks
    • 10.4.3. Controversy over Per-Prescription Fees
  • 10.5. Pharmacy Profits from the 340B Drug Pricing Program
    • 10.5.1. Overview of the 340B Program and Contract Pharmacies
    • 10.5.2. Flow of Funds with a Contract Pharmacy
    • 10.5.3. Pharmacy and Covered Entity Profits from 340B Prescriptions

Acronyms and Abbreviations

Endnotes

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LIST OF EXHIBITS

Exhibit 1: Timeline of DSCSA Requirements for Pharmacies (Dispensers), 2013-2023
Exhibit 2: Unbranded and Branded Generics, Share of U.S. Prescriptions, 2005-2021F
Exhibit 3: Specialty Drug Prescriptions As a Percentage of Pharmacy Industry Revenues, 2010-2016
Exhibit 4: Generic Dispensing Rate, Top Traditional vs. Specialty Therapy Classes, 2015
Exhibit 5: Factors Determining Health Plan Classification As Specialty Therapy
Exhibit 6: Top 10 Traditional Therapy Categories and Average Prescription Cost, 2015
Exhibit 7: Top 10 Specialty Therapy Categories and Average Prescription Cost, 2015
Exhibit 8: Long-Term Care Pharmacy, Customer Mix, by Pharmacy Ownership, 2015
Exhibit 9: Average Revenue per 30-Day Equivalent Prescription, by Dispensing Format, 2010-2016E
Exhibit 10: Average Annual Number of Prescriptions per Pharmacy, by Retail Dispensing Format, 2016
Exhibit 11: Prescriptions Dispensed per Location, by Dispensing Format, 2006-2016
Exhibit 12: Average Annual Prescription Revenue per Pharmacy Outlet, by Retail Dispensing Format, 2016
Exhibit 13: Top Three Reasons for Pharmacy Selection, by Dispensing Format, 2016
Exhibit 14: Customer Satisfaction With Pharmacies, by Dispensing Format, 2016
Exhibit 15: Pharmacist Employment and Salary, by Dispensing Format, 2015
Exhibit 16: Pharmacists and Healthcare Workers, Change in Annual Average Salary, by Employer, 2011-2015
Exhibit 17: Pharmacist Employment, by Dispensing Format, 2015 vs. 2024
Exhibit 18: Number of U.S. Retail Clinics, 2004-2016
Exhibit 19: Location of Retail Clinics, by Chain, 2017
Exhibit 20: Providers of Medication Therapy Management Services, Medicare Part D, 2016
Exhibit 21: Current Procedural Terminology (CPT) Codes Used by Pharmacists
Exhibit 22: Pharmacists’ Rating of Workload, by Dispensing Format, 2004 vs. 2014
Exhibit 23: Adult Influenza Vaccination, by Place of Vaccination, 2012-13 vs. 2016-17
Exhibit 24: Total U.S. Pharmacy Industry Prescription Revenues, Prescriptions, and Locations, by Dispensing Format, 2016
Exhibit 25: Prescriptions, Annual Total and Growth, 2011-2016E
Exhibit 26: 30-Day Equivalent Prescriptions, Annual Total and Growth, 2011-2016E
Exhibit 27: 90-Day Prescriptions As a Percentage of Total Prescriptions, by Dispensing Format, 2011 vs. 2016E
Exhibit 28: Pharmacy Industry Prescription Revenues, Annual Total and Growth, 2011-2016E
Exhibit 29: Largest 15 U.S. Pharmacies, by Total Prescription Revenues, 2016
Exhibit 30: Total Change in 30-Day Equivalent Prescriptions Dispensed and Prescription Revenues, by Pharmacy Format, 2011-2016E
Exhibit 31: Number of Pharmacies, by Dispensing Format, 2011 vs. 2016
Exhibit 32: Number of 30-Day Equivalent Prescriptions, by Dispensing Format, 2015 vs. 2016E
Exhibit 33: Prescription Dispensing Revenues, by Dispensing Format, 2015 vs. 2016E
Exhibit 34: Year-Over-Year Change in Same-Store Prescription Count, 2013-2016
Exhibit 35: Largest Regional Chain Drugstores, by Total Prescription Revenues, 2015
Exhibit 36: Number of Independent Pharmacies, 1991-2016
Exhibit 37: Pharmacy Franchise and Marketing Programs, 2016
Exhibit 38: Share of Mail Pharmacy Dispensing Revenues, by Company, 2016
Exhibit 39: Specialty Prescription Dispensing Revenues, Annual Total and Growth, 2011-2016E
Exhibit 40: Number of Pharmacy Locations With Specialty Pharmacy Accreditation, URAC vs. ACHC, December 2016
Exhibit 41: Locations With URAC Specialty Pharmacy Accreditation, 2008-2016
Exhibit 42: Prescription Revenues and Market Share from Specialty Pharmaceuticals, by Company, 2016
Exhibit 43: Specialty Pharmacy Mergers and Acquisition Transactions, 2008-2015
Exhibit 44: Pharmacy Locations With Specialty Pharmacy Accreditation, by Corporate Ownership, 2015 vs. 2016
Exhibit 45: Specialty Drug Prescription Revenues, by Dispensing Format, 2016
Exhibit 46: Fastest-Growing Private Specialty Pharmacies, 2015
Exhibit 47: Retail Chains With Specialty Pharmacy Businesses, 2016
Exhibit 48: Hospital Systems’ Specialty Pharmacy Capabilities and Intentions, 2016
Exhibit 49: Patient-Administered Oncology Volume, by Dispensing Channel, 2015
Exhibit 50: Alternative Channels to Specialty Pharmacies in Limited Dispensing Networks
Exhibit 51: Leading Specialty Hub Services Providers, 2016
Exhibit 52: Number of U.S. Biosimilar Development Programs, 2013 to 2016
Exhibit 53: Chapter Coverage of Flows in the U.S. Distribution and Reimbursement System
Exhibit 54: Health Insurance Enrollment, by Payer, 2005 vs. 2015
Exhibit 55: Prescription Expenses per Person, by Age, 2014
Exhibit 56: Share of U.S. National Health Expenditures, by Major Spending Category, 1974-2024
Exhibit 57: Outpatient Prescription Drugs As a Share of U.S. National Health Expenditures, by Payer, 2005 vs. 2015
Exhibit 58: Source of Payment for Outpatient Prescription Drug Expenditures, 2015
Exhibit 59: Change in Net Spending for Outpatient Prescription Drugs, by Payer, 2014 vs. 2015
Exhibit 60: Consumers’ Out-of-Pocket Spending Share of Outpatient Prescription Drug Expenditures, 1965-2015
Exhibit 61: Change in Drug Spending, Traditional vs. Specialty Drugs, by Payer, 2015
Exhibit 62: Change in Gross Pharmacy Benefit Drug Spending, Traditional vs. Specialty Drugs, 2002 to 2015
Exhibit 63: Components of Changes in Traditional Drug Spending, by Payer, 2015
Exhibit 64: Components of Changes in Specialty Drug Spending, by Payer, 2015
Exhibit 65: Brand Revenues Lost to Generic Launches, 2009 to 2019
Exhibit 66: Pharmacy Industry Prescription Revenues, Traditional vs. Specialty Drugs, 2011-2021
Exhibit 67: Projected Growth Rates in National Health and Outpatient Prescription Drug Expenditures, 2012-2025
Exhibit 68: Source of Payment for Outpatient Prescription Drug Expenditures, 2025 (July 2016 CMS Projection)
Exhibit 69: Source of Payment for Outpatient Prescription Drug Expenditures, 2025 (ACA Repeal-and-Replace Scenario)
Exhibit 70: Common Pharmacy Benefit Plan Designs
Exhibit 71: Prevalence of Utilization Management Tools to Manage Specialty Drug Costs, by Employer Size, 2016
Exhibit 72: PBM Market Share, by Total Equivalent Prescription Claims Managed, 2016
Exhibit 73: U.S. Manufacturer Rebates and Discounts, Value and Share of Gross Revenues, 2008 to 2015
Exhibit 74: Medicaid, Gross vs. Net Spending on Outpatient Drugs, 2015
Exhibit 75: Proportion of Commercial Lives in Plans With Formulary Exclusions, by PBM, 2016
Exhibit 76: Number of Products on PBM Formulary Exclusion Lists, 2012-2016
Exhibit 77: Formulary Exclusions for Specialty Drugs, Medicare Part D, 2016
Exhibit 78: Percentage of Employers Receiving Rebates for Brand and Specialty Drugs, by Employer Size, 2015
Exhibit 79: PBM Rebate Arrangements for Brand and Specialty Medications, Employer-Sponsored Plans, 2015
Exhibit 80: Price Increases for Brand-Name Drugs, Invoice vs. Net Price Growth, 2011-2015
Exhibit 81: Largest Pharmacy Services Administration Organizations, by Members and Ownership, 2016
Exhibit 82: Key Components of PBM Compensation
Exhibit 83: Plan Sponsors’ Satisfaction With Their PBMs, by Degree of Transparency, 2016
Exhibit 84: Plan Sponsors’ Perceived Transparency of PBM Relationship, by PBM Size, 2016
Exhibit 85: PBM Compensation Approach, 2014 to 2016
Exhibit 86: Average Patient Out-of-Pocket Costs, by Type of Prescription, 2011 vs. 2016
Exhibit 87: Distribution of Cost Sharing Formulas for Prescription Drug Benefits in Employer-Sponsored Plans, 2004 vs. 2016
Exhibit 88: Average Copayments by Prescription Drug Tier, Employer-Sponsored Plans, 2004 vs. 2016
Exhibit 89: Cost Sharing Arrangements for Prescription Drug Benefits in Employer-Sponsored Plans, 2016
Exhibit 90: Average Copayments by Prescription Drug Tier, Bronze vs. Platinum Health Insurance Marketplace Plans, 2016
Exhibit 91: Type of Cost Sharing for Prescription Drug Benefits, Health Insurance Marketplace Plans, Platinum Plans, 2016
Exhibit 92: Median Copayments by Prescription Drug Tier, Medicare Part D Plans, 2016
Exhibit 93: Prevalence of Coinsurance for Brand-Name Drugs, Medicare Part D Plans, 2016
Exhibit 94: Coinsurance Rates for Specialty Drugs, Medicare Part D Plans, 2016
Exhibit 95: Percentage of Employer-Sponsored Plans With Pharmacy Benefit Deductibles, 2012 to 2016
Exhibit 96: Pharmacy Benefit Deductible Amounts, by Plan Type, 2016
Exhibit 97: Percentage of Health Insurance Marketplace Plans With Separate Prescription Drug Deductible, 2016
Exhibit 98: Standard Medicare Prescription Drug Benefit, 2017
Exhibit 99: CVS Health, Quarterly Retail Prescription Revenues, 2010 to 2015
Exhibit 100: Sources of Free Trial Vouchers, Coupons, and Copay Cards, 2014 vs. 2016
Exhibit 101: Prevalence of Copayment Offset Programs for Specialty Drugs, 2016
Exhibit 102: Average Annual Benefit for Copayment Offset Program, by Specialty Therapy Class, 2016
Exhibit 103: Employer Views on Specialty Copayment Assistance Programs, 2016
Exhibit 104: Summary of Pharmacy Benefit Network Design Options
Exhibit 105: Median Copayments at Preferred vs. Standard Pharmacies, Medicare Part D, 2016
Exhibit 106: Medicare Part D PDPs With Preferred Pharmacy Networks, 2011-2017
Exhibit 107: Participation As Preferred Cost Sharing Pharmacies in Selected Medicare Part D PDPs, by Retail Chain, 2017
Exhibit 108: Participation As Preferred Cost Sharing Pharmacies in Selected Medicare Part D PDPs, by PSAO, 2017
Exhibit 109: Retail Pharmacy Network Design in Employer-Sponsored Plans, 2013 to 2016
Exhibit 110: CVS Health, Maintenance Choice Covered Lives, 2009 to 2016
Exhibit 111: Share of Hepatitis C Virus (HCV) Drug Expenditures, by Dispensing Format, 2015
Exhibit 112: Employer Perceptions of Specialty vs. Retail Pharmacies, 2015
Exhibit 113: Payer Methodologies for Computing a Pharmacy’s Estimated Acquisition Cost
Exhibit 114: Average Dispensing Fee for Brand-Name Prescriptions at Retail Pharmacies, 1999 to 2015
Exhibit 115: AWP Reimbursement and Copayments for Brand-Name Prescriptions, by Dispensing Format, 2015/16
Exhibit 116: Reimbursement of Specialty Drug Prescriptions at Specialty Pharmacies, Percentage of Average Wholesale Price, 2006 to 2015
Exhibit 117: AWP Reimbursement and Copayments for Generic Prescriptions, by Dispensing Format, 2015/16
Exhibit 118: Acquisition Cost Methodologies for Pharmacy Reimbursement Used by State Medicaid Programs, 2016
Exhibit 119: Example of Brand-Name Prescription Economics for a Third-Party Payer
Exhibit 120: Follow the Dollar Flows for Brand-Name Prescription Economics
Exhibit 121: U.S. Drug Distribution and Related Revenues at Big Three Wholesalers, 2016
Exhibit 122: Full-Line Wholesaler Sales to Retail Chain Warehouses, 2008 to 2015
Exhibit 123: Largest U.S. Pharmacies and Their Primary Wholesale Suppliers, 2016
Exhibit 124: Determination of a Pharmacy’s Brand-Name Drug Acquisition Cost from a Wholesaler
Exhibit 125: Pharmacy Buying Groups and Primary/Preferred Wholesaler Relationships, by Participating Pharmacies, 2016
Exhibit 126: Share of U.S. Generic Purchasing Volume, by Organization, 2016
Exhibit 127: Overall Gross Margins for Chain and Independent Drugstores, 1993-2014
Exhibit 128: Total Gross Profits for Chain and Independent Drugstores, 2006-2014
Exhibit 129: Overall Gross Margins for Chain Drugstores, by Company, 2015
Exhibit 130: Example of Brand-Name Prescription Economics for a Pharmacy
Exhibit 131: Independent Pharmacies, Average Per-Prescription Gross Profits and Margins, 2011-2016
Exhibit 132: Diplomat Pharmacy, Average Per-Prescription Gross Profits and Margins, 2011-2016
Exhibit 133: PharMerica, Average Per-Prescription Gross Profits and Margins, 2011-2016
Exhibit 134: PBM, Average Per-Prescription Gross Profit and Gross Margin, by Dispensing Channel and Drug Type, 2016
Exhibit 135: Average Year-Over-Year Change in List Price, Top Best-Selling Brand-Name Drugs, 2005-2016
Exhibit 136: Illustrative Effect of Brand-Name List Price Increases on a Prescription’s Gross Profit
Exhibit 137: Lifecycle of Per-Prescription Gross Profits, Brand vs. Multisource Generic
Exhibit 138: Average Generic Price Relative to Brand Price After Loss of Exclusivity
Exhibit 139: Examples of Pharmacy Acquisition Cost, Brand-Name vs. Generic Drug, 2016
Exhibit 140: Average Year-Over-Year Change in Pricing of Mature Generic Drugs, 2014-2016
Exhibit 141: 340B Contract Pharmacy Locations, by Chain, 2016
Exhibit 142: Flow of Funds and Product for a 340B Contract Pharmacy Network
Exhibit 143: Hypothetical Profits for a 340B Entity From a Third-Party Prescription Dispensed by a 340B Contract Pharmacy

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