Putting it all together
You've met the pieces — benchmarks, programs, players. Here they are on one page: who's who, how a drug actually travels from factory to patient, and why its price never sits still along the way.
The players, in one glance
A drug's journey, and its moving price
Why the price never sits still
A single drug doesn't have “a price” — it has a different one at every hop, and each is set by someone with different incentives:
- It starts high. The manufacturer sets the WAC — the list price — and it climbs over time, because a higher list price funds bigger rebates.
- Rebates pull it down, invisibly. The manufacturer hands a chunk back to the PBM as a rebate in exchange for a good formulary spot. That gap between list and net is money the patient at the counter usually never sees.
- What pharmacies actually pay is lower still. NADAC— surveyed from real pharmacy invoices — is the closest thing to a true acquisition cost, and it's the number this whole site is built around.
- Reimbursement is a separate number. The PBM decides what to pay the pharmacy — sometimes less than the pharmacy paid, which is how a store can lose money on a fill.
- The patient pays yet another number. A copay or coinsurance, often calculated off the list price rather than the rebated net — so the patient can pay more than the plan does.
Follow a single $100 list price all the way through, and watch where the money actually lands:
The through-line
Almost every fight in drug pricing — biosimilar uptake, PBM reform, Medicare negotiation, 340B — is really a fight over which of these numbers wins and who keeps the gap between them. Once you can see the gaps, the headlines make sense.
Now go see it live
Every benchmark in this guide is on the site as real, daily-updated data. Search any drug to see its NADAC, WAC, and ASP side by side; watch the shortages and fragility scores that these economics create; or trace where Medicaid's billions actually go.