The 2018 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers

by Adam J. Fein, Ph.D.
Available February 27, 2018. Special launch pricing will be available until March 10, 2018.

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The 2018 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers (known prior to 2017 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, hospitals, 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. This ninth edition integrates information about pharmacy dispensing channels, third-party payers, pharmacy benefit managers (PBMs), patients’ financial contributions, and drug wholesalers.

The 2018 edition updates all market and industry data with the most current information available, including our annual analyses on the market positions of the largest pharmacies and PBMs. There are also many significant updates to the 2018 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.

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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. Top 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. Medication Therapy Management (MTM), Clinical Services, and Provider Status
    • 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: 2012 to 2017 Trends
    • 2.3.2. Market Changes in 2017
    • 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 Pharmacy Industry Market Size
    • 3.2.2. Number of Accredited Specialty Pharmacies
    • 3.2.3. National Market Share for Specialty Dispensing, by Company
    • 3.2.3. Mergers & Acquisitions Among Specialty Pharmacies in 2017
  • 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 2016
    • 4.2.1. Payment for Outpatient Prescription Drugs in 2016
    • 4.2.2. Trends in Drug Spending for 2016 by Payer
    • 4.2.3. Trends in Drug Spending for 2016: Traditional vs. Specialty
    • 4.2.4. Deconstructing Changes in Cost vs. Utilization
  • 4.3. The Drug Spending Outlook
    • 4.3.1. Generic Drugs and the Specialty Boom
    • 4.3.2. U.S. Net Drug Spending Projections
    • 4.3.3. Projections for Payment of Outpatient Prescription Drugs in 2026

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. Rebates
    • 5.3.1. Gross-to-Net Drug Pricing
    • 5.3.2. How Commercial Payers Access Rebates
    • 5.3.3. Rebates and DIR in Medicare Part D
    • 5.3.4. The Medicaid Drug Rebate Program
    • 5.3.5. Formulary Exclusions
  • 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 Administrative Organizations (PSAOs)
  • 5.5. PBM Compensation by Plan Sponsors
    • 5.5.1. Spread Pricing
    • 5.5.2. Pass-Through Pricing
    • 5.5.3. Plan Sponsors’ Satisfaction With PBMs

Chapter 6: Consumer Copayments and Coinsurance

  • 6.1. Cost Sharing in Pharmacy Benefit Design
    • 6.1.1. Employer-Sponsored Health Plans
    • 6.1.2. Health Insurance Marketplace Plans
    • 6.1.3. Medicare Part D
    • 6.1.4. Medicaid
  • 6.2. Manufacturer Out-of-Pocket Payment Support
    • 6.2.1. Copayment Offset Programs
    • 6.2.2. Patient Assistance Programs
  • 6.3. Out-of-Pocket Expenses
    • 6.3.1. Average Patient Out-of-Pocket Spending on Prescriptions
    • 6.3.2. Point-of-Sale (POS) Rebates

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
    • 7.1.3. Legal and Regulatory Restrictions on Network Design
  • 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 Smaller Pharmacies
    • 9.2.2. Wholesale Suppliers to Largest U.S. Pharmacies
  • 9.3. Determinants of Pharmacies’ Acquisition Costs
    • 9.3.1. Wholesaler Pricing of Brand-Name Drugs to Pharmacies
    • 9.3.2. Wholesaler Pricing 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. Cash-Pay Prescriptions
  • 10.4. DIR Fees in Medicare Part D Networks
    • 10.4.1. Computation of DIR Fees
    • 10.4.2. Financial Impact of DIR Fees
    • 10.4.3. Controversy Over DIR Fees
  • 10.5. Pharmacy Profits from the 340B Drug Pricing Program
    • 10.5.1. Overview of the 340B Program
    • 10.5.2. 340B Contract Pharmacies
    • 10.5.3. Flow of Funds with a Contract Pharmacy
    • 10.5.4. Pharmacy and Covered Entity Profits from 340B Prescriptions
    • 10.5.5. 2018 Outlook for 340B Program

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, 2002-2022F
Exhibit 3: Generic Dispensing Rate, Top Traditional vs. Specialty Therapy Classes, 2016
Exhibit 4: Top Traditional Therapy Categories and Average Prescription Cost, 2016
Exhibit 5: Top Specialty Therapy Categories and Average Prescription Cost, 2016
Exhibit 6: Long-Term Care Pharmacy, Customer Mix, by Pharmacy Ownership, 2015
Exhibit 7: Average Annual Number of Prescriptions per Pharmacy, by Retail Dispensing Format, 2017
Exhibit 8: Average Annual Prescription Revenue per Pharmacy Outlet, by Retail Dispensing Format, 2017
Exhibit 9: Average Revenue per 30-Day Equivalent Prescription, by Dispensing Format, 2012-2017
Exhibit 10: Top Four Reasons for Pharmacy Selection, by Dispensing Format, 2016
Exhibit 11: Customer Satisfaction With Pharmacies, by Dispensing Format, 2017
Exhibit 12: Pharmacist Employment and Salaries, by Dispensing Format, 2016
Exhibit 13: Pharmacists and Healthcare Workers, Change in Annual Average Salary, by Employer, 2011-2016
Exhibit 14: Pharmacist Employment, by Industry and Dispensing Format, 2016 vs. 2026
Exhibit 15: Number of U.S. Retail Clinics, 2004-2017
Exhibit 16: Number of Retail Clinics, by Chain Location, 2018
Exhibit 17: Providers of Medication Therapy Management Services, Medicare Part D, 2016 vs. 2017
Exhibit 18: Current Procedural Terminology (CPT) Codes Used by Pharmacists
Exhibit 19: Adult Influenza Vaccination, by Place of Vaccination, 2012-13 vs. 2017-18
Exhibit 20: Consumer Use of Immunization Shots, by Dispensing Format, 2016
Exhibit 21: Total U.S. Pharmacy Industry Prescription Revenues, Prescriptions, and Locations, by Dispensing Format, 2017
Exhibit 22: Prescriptions, Annual Total and Growth, 2012-2017
Exhibit 23: 30-Day Equivalent Prescriptions, Annual Total and Growth, 2012-2017
Exhibit 24: 90-Day Prescriptions As a Percentage of Total Prescriptions, by Dispensing Format, 2012 vs. 2017
Exhibit 25: Pharmacy Industry Prescription Revenues, Annual Total and Growth, 2012-2017
Exhibit 26: Largest 15 U.S. Pharmacies, by Total Prescription Revenues, 2017
Exhibit 27: Total Change in 30-Day Equivalent Prescriptions Dispensed and Prescription Revenues, by Pharmacy Format, 2012-2017E
Exhibit 28: Prescriptions Dispensed per Location, Chain Drugstores vs. Independent Pharmacies, 2008-2017
Exhibit 29: Number of 30-Day Equivalent Prescriptions, by Dispensing Format, 2016 vs. 2017E
Exhibit 30: Prescription Dispensing Revenues, by Dispensing Format, 2016 vs. 2017E
Exhibit 31: Year-Over-Year Change in Same-Store Prescription Count, by Chain, 2013-2017
Exhibit 32: Largest Regional Chain Drugstores, by Total Prescription Revenues, 2016
Exhibit 33: Number of Independent Pharmacies, 1992-2017
Exhibit 34: Pharmacy Franchise and Marketing Programs, 2016
Exhibit 35: Share of Mail Pharmacy Dispensing Revenues, by Company, 2017
Exhibit 36: Employer Perceptions of Specialty vs. Retail Pharmacies, 2014 vs. 2017
Exhibit 37: Specialty Prescription Dispensing Revenues, Annual Total and Growth, 2012-2017
Exhibit 38: Specialty Drugs As a Percentage of Pharmacy Industry Prescription Revenues, 2011-2017
Exhibit 39: Specialty Drugs As a Percentage of Pharmacy Benefit Spending, by PBM, 2011 vs. 2016
Exhibit 40: Number of Pharmacy Locations With Specialty Pharmacy Accreditation, by Organization, 2015 to 2017
Exhibit 41: Locations With URAC Specialty Pharmacy Accreditation, 2008-2018E
Exhibit 42: Prescription Revenues and Market Share from Specialty Pharmaceuticals, by Company, 2017
Exhibit 43: Merger and Acquisition Transactions, Specialty Pharmacy and Infusion Services, 2007-2016
Exhibit 44: Pharmacy Locations With Specialty Pharmacy Accreditation, by Corporate Ownership, 2015 vs. 2016
Exhibit 45: Specialty Drug Prescription Revenues, by Dispensing Format, 2017
Exhibit 46: Specialty Drug Spending, by Dispensing Channel and Therapeutic Class, 2017
Exhibit 47: Fastest-Growing Private Specialty Pharmacies, 2016
Exhibit 48: Retail Chains With Specialty Pharmacy Businesses, 2017
Exhibit 49: Hospital Ownership of Specialty Pharmacy, by Number of Staffed Beds, 2016
Exhibit 50: Percentage of Oncology Practices With In-Practice Oral Oncology Drug Dispensing, 2013-2016
Exhibit 51: Patient-Administered Oncology Volume, by Dispensing Channel, 2016
Exhibit 52: Alternative Channels to Specialty Pharmacies in Limited Dispensing Networks
Exhibit 53: Diplomat Pharmacy, Drug Purchases, by Supplier, 2012-2017
Exhibit 54: Leading Specialty Hub Services Providers, 2017
Exhibit 55: Number of U.S. Biosimilar Development Programs, 2013 to 2017
Exhibit 56: Chapter Coverage of Flows in the U.S. Distribution and Reimbursement System
Exhibit 57: Health Insurance Enrollment, by Payer, 2006 vs. 2016
Exhibit 58: Share of U.S. National Health Expenditures, by Category, 2016
Exhibit 59: Share of U.S. National Health Expenditures, by Major Spending Category, 1976 to 2016
Exhibit 60: Outpatient Prescription Drugs As a Share of U.S. National Health Expenditures, by Payer, 2005 vs. 2016
Exhibit 61: Prescription Expenses per Person, by Age, 2014
Exhibit 62: Source of Payment for Outpatient Prescription Drug Expenditures, 2016
Exhibit 63: Change in Net Spending for Outpatient Prescription Drugs, by Payer, 2015 vs. 2016
Exhibit 64: Annual Growth in National Health and Outpatient Prescription Drug Expenditures, 2007 to 2016
Exhibit 65: Change in Commercial Payer Drug Spending, Traditional vs. Specialty Drugs, by PBM, 2016
Exhibit 66: Express Scripts, Change in Drug Spending, Traditional vs. Specialty Drugs, by Payer, 2016
Exhibit 67: Components of Change in Commercial Payer Drug Spending, by PBM, 2016
Exhibit 68: Components of Change in Specialty Drug Spending, by PBM, 2016
Exhibit 69: Brand Revenues Lost to Generic Launches, 2009 to 2022
Exhibit 70: Pharmacy Industry Prescription Revenues, Traditional vs. Specialty Drugs, 2012-2022
Exhibit 71: Projected Growth Rates in National Health and Outpatient Prescription Drug Expenditures, 2016 to 2026
Exhibit 72: Source of Payment for Outpatient Prescription Drug Expenditures, 2022
Exhibit 73: Pharmacy Benefit Management Contracting Approach, by Company Size, 2017
Exhibit 74: Prevalence of Utilization Management Tools to Manage Specialty Drug Costs, Employer-Sponsored Health Plans, 2015 vs. 2017
Exhibit 75: PBM Market Share, by Total Equivalent Prescription Claims Managed, 2017
Exhibit 76: Pharmaceutical Manufacturers’ Off-Invoice Discounts, Rebates, and Price Concessions, 2007-2016
Exhibit 77: Price Increases for Brand-Name Drugs, Invoice vs. Net Price Growth, 2011-2016
Exhibit 78: Change in List vs. Net Price, by Manufacturer, 2016
Exhibit 79: Percentage of Employers Receiving Rebates for Brand and Specialty Drugs, by Employer Size, 2017
Exhibit 80: PBM Rebate Arrangements for Traditional Medications in Employer-Sponsored Plans, by Employer Size, 2014 vs. 2017
Exhibit 81: PBM Rebate Arrangements for Specialty Medications in Employer-Sponsored Plans, by Employer Size, 2014 vs. 2017
Exhibit 82: Manufacturer Rebates As Percentage of Total Drug Costs, Medicare Part D, 2007 to 2017
Exhibit 83: Medicaid Program, Gross Spending and Prescriptions, Fee-For-Service vs. Managed Medicaid, 2016
Exhibit 84: Medicaid, Gross vs. Net Spending on Outpatient Drugs, 2015 to 2016
Exhibit 85: Number of Products on PBM Formulary Exclusion Lists, 2012-2018
Exhibit 86: PBM Formulary Exclusions, by Therapeutic Category, 2018
Exhibit 87: Largest Pharmacy Services Administrative Organizations, by Members and Ownership, 2017
Exhibit 88: Key Components of PBM Compensation
Exhibit 89: Plan Sponsors’ Perceived Transparency of PBM Relationship, by PBM Size, 2017
Exhibit 90: Plan Sponsors’ Satisfaction With Their PBMs, by Degree of Transparency, 2016
Exhibit 91: Common Pharmacy Benefit Plan Designs
Exhibit 92: Distribution of Cost Sharing Formulas for Prescription Drug Benefits in Employer-Sponsored Plans, 2004 vs. 2017
Exhibit 93: Average Copayments by Prescription Drug Tier, Employer-Sponsored Plans, 2017
Exhibit 94: Cost Sharing Arrangements for Prescription Drug Benefits in Employer-Sponsored Plans, 2017
Exhibit 95: Distribution of Coinsurance Structures for Prescription Drug Benefits, Employer-Sponsored Plans, Fourth and Specialty Tiers, 2017
Exhibit 96: Percentage of Employer-Sponsored Plans With Pharmacy Benefit Deductibles, 2012 to 2017
Exhibit 97: Percentage of Covered Workers With a Separate Prescription Drug Deductible, by Plan Type, Fourth and Specialty Tiers, 2017
Exhibit 98: Average Copayments by Prescription Drug Tier, Bronze and Silver Health Insurance Marketplace Plans, 2017
Exhibit 99: Type of Cost Sharing for Prescription Drug Benefits, Health Insurance Marketplace Plans, Silver Plans, 2017
Exhibit 100: Percentage of Silver Plans That Place All Covered Drugs in the Class on the Specialty Tier, 2014 to 2016
Exhibit 101: Standard Medicare Prescription Drug Benefit, 2017
Exhibit 102: Distribution of Cost Sharing Formulas for Medicare Part D Plans, 2017
Exhibit 103: Median Copayments by Prescription Drug Tier, Medicare Part D PDPs, 2017
Exhibit 104: Prevalence of Coinsurance for Brand-Name Drugs, Medicare Part D Plans, 2016
Exhibit 105: Median Cost Sharing Amounts for 10 Largest Medicare Part D Plans, 2017
Exhibit 106: Manufacturer Spending on Copay Offset Programs, 2010 to 2017
Exhibit 107: Prevalence of Copayment Offset Programs for Specialty Drugs, 2016 vs. 2017
Exhibit 108: Average Annual Benefit for Copayment Offset Program, by Specialty Therapy Class, 2016 vs. 2017
Exhibit 109: Employer Views on Specialty Copayment Assistance Programs, 2014 vs. 2016
Exhibit 110: Largest Pharmaceutical Manufacturer Charitable Foundations, 2014
Exhibit 111: Consumers’ Out-of-Pocket Spending Share of Outpatient Prescription Drug Expenditures, 1966-2016
Exhibit 112: Average Per-Prescription Patient Out-of-Pocket Costs, by Type of Prescription, 2013 to 2016
Exhibit 113: Distribution of Average Per-Prescription Out-of-Pocket Costs, by Type of Prescription, 2016
Exhibit 114: Distribution of Annual Patient Out-of-Pocket Costs, By Type of Health Plan, 2017
Exhibit 115: Specialty Drugs, Share of Prescriptions and Patient Out-of-Pocket Spending, By Type of Cost-Sharing, 2015
Exhibit 116: CVS Health, Quarterly Retail Prescription Revenues, 2014 to 2017
Exhibit 117: Employers’ Use of Formulary Rebates, 2017
Exhibit 118: Summary of Pharmacy Benefit Network Design Options
Exhibit 119: Medicare Part D PDPs With Preferred Pharmacy Networks, 2011-2018
Exhibit 120: Median Copayments at Preferred vs. Standard Pharmacies, Medicare Part D, 2016
Exhibit 121: Medicare Part D Beneficiary Access, Preferred Pharmacies vs. All Network Pharmacies, 2017
Exhibit 122: Participation As Preferred Cost Sharing Pharmacies in Selected Medicare Part D PDPs, by Retail Chain, 2018
Exhibit 123: Enrollment in Medicare Part D PDPs With Preferred Cost Sharing Networks, by Pharmacy Chain, 2017 vs. 2018
Exhibit 124: Participation As Preferred Cost Sharing Pharmacies in Selected Medicare Part D PDPs, by PSAO, 2018
Exhibit 125: Retail Pharmacy Network Design in Employer-Sponsored Plans, 2013 to 2017
Exhibit 126: Mandatory Mail Pharmacy Utilization for Maintenance Medications, Employer-Sponsored Plans, 2013 to 2017
Exhibit 127: TRICARE, Net Spending on Outpatient Prescriptions, by Dispensing Outlet, 2012-2016
Exhibit 128: CVS Health, Maintenance Choice Covered Lives, 2008 to 2017E
Exhibit 129: Oral Oncology Agents, by Dispensing Channel, 2009 vs. 2016
Exhibit 130: Payer Methodologies for Computing a Pharmacy’s Estimated Acquisition Cost
Exhibit 131: AWP Reimbursement and Copayments for Brand-Name Prescriptions, by Dispensing Format, 2017
Exhibit 132: AWP Reimbursement and Copayments for Generic Prescriptions, by Dispensing Format, 2017
Exhibit 133: Prescription Economics for a Third-Party Payer—Traditional Brand-Name Drug Example
Exhibit 134: Prescription Economics for a Third-Party Payer—Specialty Brand-Name Drug Example
Exhibit 135: U.S. Drug Distribution and Related Revenues at Big Three Wholesalers, 2017
Exhibit 136: Largest U.S. Pharmacies and Their Primary Wholesale Suppliers, 2017
Exhibit 137: Determination of a Pharmacy’s Brand-Name Drug Acquisition Cost from a Wholesaler
Exhibit 138: Pharmacy Buying Groups and Primary/Preferred Wholesaler Relationships, by Number of Pharmacies, 2017
Exhibit 139: Share of U.S. Generic Purchasing Volume, by Organization, 2017
Exhibit 140: Overall Gross Margins for Chain and Independent Drugstores, 1996-2015
Exhibit 141: Total Gross Profits for Chain and Independent Drugstores, 2006-2015
Exhibit 142: Overall Gross Margins for Chain Drugstores, by Company, 2016
Exhibit 143: Example of Brand-Name Prescription Economics for a Pharmacy
Exhibit 144: Independent Pharmacies, Average Per-Prescription Gross Profits and Margins, 2012 to 2016
Exhibit 145: Diplomat Pharmacy, Average Per-Prescription Gross Profits and Margins, 2012 to 2017
Exhibit 146: PharMerica, Average Per-Prescription Gross Profits and Margins, 2011-2017
Exhibit 147: PBM, Average Per-Prescription Gross Profit and Gross Margin, by Dispensing Channel and Drug Type, 2016
Exhibit 148: Illustrative Effect of Brand-Name List Price Increases on a Prescription’s Gross Profit
Exhibit 149: Lifecycle of Per-Prescription Gross Profits, Brand vs. Multisource Generic
Exhibit 150: Median AWP Discount for Generic Drugs Sold to Retail Pharmacies, By Number of Manufacturers, 2017
Exhibit 151: Average Generic Price Relative to Brand Price After Loss of Exclusivity
Exhibit 152: Gleevec, Average Pharmacy Acquisition Cost, Brand vs. Generic, 2016 to 2018
Exhibit 153: Average Year-Over-Year Change in Pricing of Mature Generic Drugs, 2014-2017
Exhibit 154: Cash-Pay Prescriptions As Share of Total Prescriptions, 2012 to 2016
Exhibit 155: Diplomat Pharmacy, DIR Fees As Percentage of Revenues and Gross Profit, 2016 vs. 2017E
Exhibit 156: 340B Contract Pharmacy Locations, by Chain, 2017
Exhibit 157: 340B Contract Pharmacy Locations, by Chain, 2013 vs. 2017
Exhibit 158: Hospital Systems With the Largest 340B Contract Pharmacy Networks, July 2017
Exhibit 159: Flow of Funds and Product for a 340B Contract Pharmacy Network
Exhibit 160: Hypothetical Profits for a 340B Entity From a Third-Party Prescription Dispensed by a 340B Contract Pharmacy

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