Reports

Bottom-Up Pricing Estimate for P-quad

How much would biologic drugs cost under P-quad pricing? Two approaches to estimating fully loaded costs plus a profit (10% and 20% examined) suggest net discounts from current prices would be at least 65% to 75%
Download Report
Originally published on 03/12/2021 Drug Pricing Lab

If the price of biologic drugs were based on cost of production plus a fixed profit of 10% to 20% ("Production Plus Profit Pricing", or P-quad) after their FDA 12-year market exclusivity, the discount from the net price would still be substantial.

Bach and Trusheim have proposed this policy, with P-quad prices based on "fully loaded" company-reported manufacturing costs (so as to include capital costs and depreciation), reported distribution expenses, and a profit substantial enough to make continued investment in production and distribution appealing for the firm.

In order to facilitate a model of P-quad's budgetary impact, we estimated the prices that the P-quad reporting-based method would generate using two approaches. Then for modeling purposes we converted these prices into discounts from current net prices and selected one of the most conservative results--a 65% to 75% discount range from the net price--for the budgetary model.

Download the full report here.

Key Takeaways

Using COGS from company financial statements, the average discount from net price ranged from 74% to 76%

Using a 'bottom-up' approach, the average discount from net price ranged from 80% to 92%

The discount range of 65% to 75% used for modeling budgetary impact of P-quad pricing was selected to be conservative and therefore undershoot the potential savings from the P-quad policy approach. That European prices through tender offers at times achieve 80%+ discounts from alower starting point, European biologic prices provides further reassurance that firms can be profitable at prices much lower than our modeled discount.

Share

Adding Cost to the Equation: The Case of Zaltrap

Read Impact Story

Research & Insights

We conduct non-partisan, independent research, and make our work accessible and informative to policymakers and the general audience alike. Browse our featured research or explore our work by article type.

The Drugs at the Heart of Our Pricing Crisis
The US drug pricing system is broken, but not irreparable. For large-molecule biologic drugs, enter: Production Plus Profit Pricing (P-quad, pronounced like Ahab's seagoing vessel).
NYTimes 03/15/2021
Modeling P-quad
The Drug Pricing Lab engaged Milliman to conduct an independent analysis of the Production Plus Profit Pricing (P-quad) policy proposal. The Milliman analysis estimates the projected spending on U.S. biologic and biosimilar drugs under a referent scenario where there is no biosimilar entry or competition, the existing ‘status quo’ scenario under the current biosimilar environment, and the Drug Pricing Lab’s P-quad policy proposal. 

This report was commissioned by Drug Pricing Lab.
Milliman 03/12/2021
Ethics of Clinical Trials to Evaluate Biosimilars
Biosimilars require extensive, expensive, and time-consuming human testing prior to market entry, a process vastly different than generics. So why are we still doing them?
MedRx IV 03/09/2021
Abandon Biosimilars as Biologics are Natural Monopolies
Biosimilars will not effectively lower the price of biologic drugs after the period of market exclusivity.
HA Blog 04/15/2019
Production Plus Profit Pricing (P-quad) for Biologic Drugs
In 2019, Peter Bach and Mark Trusheim argued that biologics are "natural monopolies". Two years later, they revisit this idea with new data.
HA Blog
Xeljanz, the FDA, and nine years of patient harm
Quantifying population-level adverse events in the near decade between when safety concerns were identified and FDA action
Drug Pricing Lab 05/31/2022
Atypical antipsychotics: Decades of use, unfathomable harms
Using attributable risk calculations to quantify how many premature deaths resulted from atypical antipsychotic use in the elderly
Drug Pricing Lab 05/31/2022
Medicare Part B Premium Dynamics Explained
The Drug Pricing Lab commissioned Milliman to prepare a report exploring the impact of changes in Medicare Part B program costs on beneficiaries’ premiums and Social Security payments. This report focuses on the 2022 Part B premium for beneficiaries with various income levels to illustrate the payment dynamics and discusses the implications for related programs.
Milliman 12/23/2021
Comparing Factors that Influence Pharmaceutical Pricing and Access in the…
Drug prices in the United States are some of the highest in the world, which has triggered several policy proposals aimed at adopting pricing strategies used by other countries.
Drug Pricing Lab 12/20/2021
Biosimilars in Medicare Part D: pricing dynamics and considerations
The Drug Pricing Lab engaged Milliman to prepare a report summarizing the pricing dynamics affecting utilization of biosimilars in the current Medicare Part D marketplace and under the proposed Part D benefit design in the Build Back Better Act.

This report was commissioned by the Drug Pricing Lab.
Milliman 12/14/2021
Evaluating Industry’s Drug Pricing Claims
A closer look at three of PhRMA’s most cited talking points.
Drug Pricing Lab 11/18/2021
Mapping conflict of interests: scoping review
A scoping review of the literature to identify all known ties between the medical product industry and the parties and activities in the healthcare ecosystem.
Drug Pricing Lab 11/03/2021
Tutorials

Learn how drug pricing works

Certain aspects of the payment and reimbursement processes in the US may distort incentives and negatively influence drug prices. Learn how through by exploring our tutorials.

Explore Our Tutorials
Newsletter

Stay up to date on our work and news