Eli5 How are drug prices settled in the US?
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I can’t speak for other insurance companies, but mine recently just dropped a whole ton of pharmacies. My insurance company is large enough where they don’t negotiate with pharmacies. They tell the pharmacy this is what we’re willing to pay and you’re either going to take it or you’re not. And if you’re not then we won’t cover you.
As far as new medications coming onto the market, unless they are considered formulary medications, the copay for them is rather steep. I think the last time I looked at the copay, non-formulary medications were $63. If there is a medical necessity for the medication then you can work with the insurance company to bring down the price to formulary prices.
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