Big Pharma

Drug rebate dollars continue to rise

Cigna's logo on a wall.
Photo: Julia Rendleman/Getty Images for Eventive Marketing

If Express Scripts is any kind of bellwether for drug rebates — pricing discounts that drug manufacturers pay to pharmacy benefit managers so their drugs get put on the drug coverage lists — then those dollars continue to rise.

By the numbers: Cigna, which bought Express Scripts last year, said it is owed almost $4 billion in rebates from pharmaceutical companies as of Sept. 30, according to new investor documents. That's up almost $600 million since the start of this year.

Big Pharma's giant promotional payouts to doctors

More than 700 doctors were paid at least $1 million by drug and medical device companies between 2014 and 2018, ProPublica reports. More than 2,500 received at least half a million dollars.

Why it matters: Many drugs that are heavily promoted have strong competition. "Promotional spending is a major way that manufacturers in these situations distinguish themselves from each other — not by conducting comparative studies or by engaging in substantial price reductions," said Aaron Kesselheim, a professor of medicine at Harvard Medical School.