Dr. Fein highlights the growing gap between the growth rate of "net price" and invoice price, as reported in, "Medicines Use and Spending in the U.S.–A Review of 2015 and Outlook to 2020 from IMS Health." We know there is a complex system of discounts (up front), rebates (paid by manufacturers to third parties like payors, etc. after the listed invoice price), etc. So, a different price is seen by the manufacturer, the distributor, the hospital, the pharmacy, and the patient, and we are unable to neatly trace changes in price along the way on a per drug basis. This iron curtain of trading hands is where we need transparency; yet, almost all of the transparency bills to date only focus on transparency around R&D spend. Further, this growing gap between net price and invoice price is harmful to patients;the rise of high-deductible health plans means more pt cost exposure to the higher invoice price with no ability to negotiate price due to opaque drug formularies & inability to make cost-effectiveness comparisons. Should patients have a seat at the drug price negotiation table to control prices? How?
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