The spread: what plans pay vs. what drugs cost
Every quarter, Medicare publishes what Part D plans' negotiated prices are at the pharmacy counter. Every week, CMS publishes what pharmacies actually paid to acquire the same drugs (NADAC). This page lines the two up, drug by drug, for the same quarter. The gap between them is the margin of the middle of the supply chain — and on generics, where rebates are small, most of it is exactly what state investigations have called spread pricing.
Median markup
1.68×
vs. pharmacy acquisition cost
Paying 2× or more
38%
of 1,134 matched drugs
Paying 5× or more
4%
1 in 25 drugs
Below cost
2%
fills that lose the pharmacy money
Where drugs land — April 2026
Part D negotiated price as a multiple of the same quarter's acquisition cost, one row per molecule.
Below cost
18
About cost
407
1.25–2×
281
2–5×
383
5–10×
31
10×+
14
ⓘ How this was built
Data sources
- CMS Part D quarterly plan pricing files (negotiated point-of-sale prices across ~5,500 plans)
- CMS NADAC weekly pharmacy acquisition cost survey (data.medicaid.gov)
- FDA NDC Directory (openFDA)
Method
For each NDC, the median Part D negotiated price across all plans is divided by the NADAC in force in the SAME quarter (comparing against today's NADAC would measure file lag, not spread). One row per molecule — its highest-markup NDC. Drugs with acquisition cost under 5¢/unit are excluded so rounding can't manufacture large ratios. All prices are gross of rebates.
Pipeline and calculations built by Claude (Fable 5) from the public datasets above. Educational only — verify against primary sources before acting.
What this means for one fill
Take Atorvastatin Calcium — 73,374,921 Part D prescriptions a year. A pharmacy acquires it for about $0.0285 a unit; the median plan's negotiated price at the counter is $0.1144 — 4.0× the drug's cost. On a 30-unit fill, that is $2.58 of spread — and when a patient's coinsurance is a percentage, it is a percentage of the marked-up price, not the real one.
Why it persists: PBMs are paid on the difference between what a plan is charged and what the pharmacy is reimbursed. The 2018-19 Ohio Medicaid audits found ~31% spreads on generics; this page is the same arithmetic, run nationally, every quarter. What else has escaped the contracts — the evidence, in plain language.
ⓘ How this was built
Data sources
- CMS Part D quarterly plan pricing files (negotiated point-of-sale prices across ~5,500 plans)
- CMS NADAC weekly pharmacy acquisition cost survey (data.medicaid.gov)
- FDA NDC Directory (openFDA)
- CMS Part D Spending by Drug (annual claims)
Method
The example is the highest-volume drug (≥1M Part D fills/yr) whose negotiated price runs 3-30× its same-quarter acquisition cost. The per-fill figure multiplies the per-unit gap by a 30-unit fill.
Pipeline and calculations built by Claude (Fable 5) from the public datasets above. Educational only — verify against primary sources before acting.
Drug by drug — filter or click a column to sort
| doxycycline hyclate doxyclycline hyclate | $23.93 | $0.3816 | 63× | 1 | — | — |
| Dapagliflozin Dapagliflozin | $6.05 | $0.1845 | 33× | 40 | — | — |
| Teriflunomide Teriflunomide | $5.90 | $0.3198 | 18× | 26 | 72,360 | $13.7M |
| Metformin Hydrochloride Metformin Hydrochloride | $4.53 | $0.2781 | 16× | 98 | — | — |
| Abiraterone Acetate abiraterone acetate | $48.49 | $3.02 | 16× | 45 | 391,472 | $1.8B |
| Ticagrelor Ticagrelor | $5.00 | $0.3240 | 15× | 54 | 1,029,007 | $441.9M |
| Cyclobenzaprine Hydrochloride Cyclobenzaprine Hydrochloride | $13.69 | $0.8887 | 15× | 75 | — | — |
| Pirfenidone Pirfenidone | $12.47 | $0.8608 | 14× | 39 | 61,750 | $123.6M |
| Tetrabenazine Tetrabenazine | $10.94 | $0.8066 | 14× | 20 | 28,194 | $20.8M |
| Imatinib Mesylate Imatinib Mesylate | $8.96 | $0.6632 | 14× | 30 | 129,504 | $50.3M |
| Metformin metformin | $1.49 | $0.1108 | 13× | 6 | — | — |
| Dasatinib Dasatinib | $301.03 | $26.32 | 11× | 25 | 44,274 | $379.5M |
| Ambrisentan Ambrisentan | $95.00 | $8.52 | 11× | 19 | 64,793 | $178.6M |
| Alyq Tadalafil | $1.51 | $0.1465 | 10× | 87 | 378,785 | $26.9M |
| Sildenafil Sildenafil citrate | $3.32 | $0.3369 | 9.9× | 52 | 838,936 | $77.9M |
| Dapsone Daspone | $7.72 | $0.7945 | 9.7× | 1 | — | — |
| Entecavir Entecavir | $3.24 | $0.3501 | 9.3× | 25 | 132,654 | $19.5M |
| Droxidopa Droxidopa | $4.06 | $0.4419 | 9.2× | 21 | 40,230 | $21.2M |
| Zileuton Zileuton | $17.64 | $1.92 | 9.2× | 14 | 11,676 | $25.9M |
| Venlafaxine Hydrochloride Venlafaxine Hydrochloride | $2.34 | $0.2655 | 8.8× | 63 | — | — |
| Tolvaptan Tolvaptan | $146.01 | $17.46 | 8.4× | 16 | 13,157 | $60.6M |
| Minocycline Hydrochloride Minocycline Hydrochloride | $14.43 | $1.73 | 8.3× | 28 | — | — |
| Dalfampridine Dalfampridine | $3.11 | $0.3928 | 7.9× | 17 | 116,928 | $25.5M |
| Sildenafil Sildenafil | $0.4126 | $0.0533 | 7.7× | 51 | — | — |
| Dimethyl Fumarate Dimethyl fumarate | $4.66 | $0.6173 | 7.5× | 41 | 75,462 | $21.1M |
| Methylphenidate Hydrochloride Methylphenidate Hydrochloride | $4.67 | $0.6192 | 7.5× | 55 | — | — |
| Saxagliptin Saxagliptin | $8.72 | $1.18 | 7.4× | 6 | — | — |
| Doxycycline Doxycycline | $4.67 | $0.6952 | 6.7× | 64 | — | — |
| Hydrocodone Bitartrate and Acetaminophen Hydrocodone Bitartrate and Acetaminophen | $1.08 | $0.1623 | 6.7× | 37 | — | — |
| Efavirenz, Emtricitabine and Tenofovir Disoproxil Fumarate Efavirenz, Emtricitabine and Tenofovir Disoproxil Fumarate | $7.65 | $1.17 | 6.5× | 7 | — | — |
| Eslicarbazepine Acetate Eslicarbazepine Acetate | $12.79 | $2.06 | 6.2× | 22 | 83,810 | $36.0M |
| Trientine hydrochloride Trientine hydrochloride | $13.99 | $2.30 | 6.1× | 16 | — | — |
| Mycophenolic Acid Mycophenolic Acid | $0.6551 | $0.1103 | 5.9× | 23 | — | — |
| Diflorasone Diacetate Diflorasone Diacetate | $7.86 | $1.34 | 5.9× | 4 | 28,642 | $15.1M |
| Darifenacin Darifenacin | $2.30 | $0.4013 | 5.7× | 7 | — | — |
| Amcinonide Amcinonide | $27.81 | $4.90 | 5.7× | 5 | 2,328 | $4.4M |
| Doxycycline hyclate Doxycycline hyclate | $3.91 | $0.6934 | 5.6× | 75 | 6,668,225 | $547.4M |
| Ivabradine Ivabradine | $4.12 | $0.7371 | 5.6× | 12 | — | — |
| Fingolimod Hydrochloride Fingolimod Hydrochloride | $19.76 | $3.56 | 5.5× | 15 | — | — |
| Venlafaxine Hydrochloride venlafaxine | $2.73 | $0.4938 | 5.5× | 30 | — | — |
| Imiquimod imiquimod | $132.93 | $24.39 | 5.4× | 20 | 213,473 | $424.9M |
| Dapsone dapsone | $3.89 | $0.7146 | 5.4× | 41 | 96,605 | $21.2M |
| Hydrocortisone Butyrate Hydrocortisone Butyrate | $3.76 | $0.6999 | 5.4× | 9 | 16,202 | $5.5M |
| Vandazole Metronidazole | $1.71 | $0.3326 | 5.1× | 73 | 2,265,997 | $106.3M |
| Rivaroxaban Rivaroxaban | $4.05 | $0.7967 | 5.1× | 56 | 6,660,246 | $1.2B |
| Sirolimus Sirolimus | $14.17 | $2.85 | 5.0× | 40 | 40,712 | $36.3M |
| Tobramycin Tobramycin | $5.40 | $1.09 | 4.9× | 45 | 248,764 | $7.1M |
| Torpenz Everolimus | $72.50 | $14.77 | 4.9× | 25 | 41,989 | $147.7M |
| Diclofenac Sodium Diclofenac Sodium | $1.76 | $0.3625 | 4.9× | 132 | 6,885,106 | $1.1B |
| bexarotene bexarotene | $27.14 | $5.60 | 4.8× | 17 | 7,109 | $14.9M |
| gabapentin gabapentin | $5.05 | $1.05 | 4.8× | 128 | 36,837,037 | $18.4B |
| Famotidine Famotidine | $0.6747 | $0.1440 | 4.7× | 166 | 14,045,191 | $587.1M |
| Emtricitabine and Tenofovir Disoproxil Fumarate Emtricitabine and Tenofovir Disoproxil Fumarate | $2.13 | $0.4566 | 4.7× | 28 | — | — |
| Posaconazole Posaconazole | $10.70 | $2.30 | 4.7× | 44 | 43,821 | $33.3M |
| Prucalopride Prucalopride | $3.13 | $0.6735 | 4.6× | 18 | — | — |
| Varenicline varenicline tartrate | $1.46 | $0.3191 | 4.6× | 35 | 660,035 | $44.7M |
| Pregabalin Pregabalin | $9.12 | $2.05 | 4.4× | 85 | 7,578,719 | $4.6B |
| Rufinamide Rufinamide | $1.01 | $0.2262 | 4.4× | 20 | 27,609 | $7.0M |
| Metaxalone Metaxalone | $1.73 | $0.3926 | 4.4× | 41 | 71,567 | $7.6M |
| Alprazolam Alprazolam | $1.42 | $0.3214 | 4.4× | 42 | 11,711,922 | $738.8M |
| Loperamide Hydrochloride Loperamide Hydrochloride | $0.2378 | $0.0541 | 4.4× | 101 | — | — |
| Mycophenolate mofetil Mycophenolate mofetil | $4.08 | $0.9324 | 4.4× | 53 | 518,400 | $304.4M |
| tenofovir disoproxil fumarate tenofovir disoproxil fumarate | $1.35 | $0.3107 | 4.3× | 32 | 83,897 | $4.6M |
| Tacrolimus Tacrolimus | $2.77 | $0.6505 | 4.3× | 54 | 670,966 | $153.0M |
| tizanidine hydrochloride tizanidine hydrochloride | $0.3844 | $0.0918 | 4.2× | 36 | — | — |
| Dipyridamole Dipyridamole | $0.9927 | $0.2410 | 4.1× | 14 | 12,019 | $1.2M |
| Tiadylt Er diltiazem hydrochloride | $0.3638 | $0.0891 | 4.1× | 67 | — | — |
| Amphetamine Sulfate Amphetamine Sulfate | $1.53 | $0.3780 | 4.1× | 16 | 1,070 | $105K |
| Tetracycline Hydrochloride Tetracycline Hydrochloride | $1.09 | $0.2691 | 4.0× | 20 | — | — |
| Mupirocin Mupirocin | $3.09 | $0.7643 | 4.0× | 33 | 3,920,145 | $217.0M |
| Frovatriptan frovatriptan succinate | $13.12 | $3.26 | 4.0× | 8 | 8,298 | $1.2M |
| Bupropion Hydrochloride XL bupropion hydrochloride | $0.3171 | $0.0790 | 4.0× | 93 | — | — |
| Pramipexole dihydrochloride Pramipexole dihydrochloride | $3.51 | $0.8759 | 4.0× | 26 | — | — |
| Clomipramine Hydrochloride Clomipramine Hydrochloride | $0.7308 | $0.1824 | 4.0× | 24 | — | — |
| Quetiapine Quetiapine | $0.2031 | $0.0512 | 4.0× | 30 | — | — |
| Cyproheptadine Hydrochloride Cyproheptadine Hydrochloride | $0.2606 | $0.0662 | 3.9× | 31 | — | — |
| Desonide Desonide | $1.00 | $0.2562 | 3.9× | 19 | 176,861 | $6.0M |
| Aripiprazole Aripiprazole | $0.3833 | $0.0980 | 3.9× | 70 | 4,111,568 | $45.8M |
| Chlorpromazine Hydrochloride Chlorpromazine Hydrochloride | $2.74 | $0.7066 | 3.9× | 38 | — | — |
| Efavirenz Efavirenz | $5.55 | $1.43 | 3.9× | 15 | 10,906 | $1.9M |
| ADAPALENE and BENZOYL PEROXIDE ADAPALENE and BENZOYL PEROXIDE | $1.13 | $0.2916 | 3.9× | 10 | — | — |
| Calcipotriene and Betamethasone Dipropionate Calcipotriene and Betamethasone Dipropionate | $5.04 | $1.30 | 3.9× | 6 | — | — |
| Atazanavir Sulfate Atazanavir | $4.15 | $1.09 | 3.8× | 6 | — | — |
| Abacavir and Lamivudine Abacavir and lamivudine | $5.53 | $1.45 | 3.8× | 5 | — | — |
| Nadolol Nadolol | $0.9965 | $0.2645 | 3.8× | 21 | 262,420 | $15.3M |
| Naproxen and esomeprazole magnesium Naproxen and esomeprazole magnesium | $9.31 | $2.47 | 3.8× | 11 | — | — |
| Fenofibrate Fenofibrate | $0.3149 | $0.0839 | 3.8× | 66 | 2,044,078 | $34.4M |
| Baclofen Baclofen | $0.2368 | $0.0632 | 3.7× | 88 | 5,181,892 | $84.1M |
| Celecoxib Celecoxib | $0.3005 | $0.0807 | 3.7× | 83 | 5,714,441 | $84.0M |
| Mefenamic acid Mefenamic acid | $3.56 | $0.9590 | 3.7× | 12 | 320 | $49K |
| Olanzapine Olanzapine | $0.3183 | $0.0867 | 3.7× | 60 | 3,988,917 | $35.1M |
| sevelamer hydrochloride sevelamer hydrochloride | $2.71 | $0.7453 | 3.6× | 13 | — | — |
| Rasagiline Rasagiline | $2.43 | $0.6667 | 3.6× | 10 | — | — |
| Bromfenac Ophthalmic Solution 0.09% Bromfenac Ophthalmic Solution 0.09% | $57.32 | $15.83 | 3.6× | 1 | — | — |
| Omeprazole and Sodium Bicarbonate Omeprazole and Sodium Bicarbonate | $2.15 | $0.5943 | 3.6× | 10 | — | — |
| Brimonidine Tartrate and Timolol Maleate Brimonidine Tartrate and Timolol Maleate | $10.31 | $2.88 | 3.6× | 13 | — | — |
| Fluconazole Fluconazole | $1.48 | $0.4161 | 3.6× | 58 | 3,763,535 | $28.2M |
| Lovenox enoxaparin sodium | $24.15 | $6.78 | 3.6× | 23 | 533,899 | $119.0M |
| deferasirox deferasirox | $5.33 | $1.50 | 3.6× | 38 | 20,271 | $6.2M |
| Lurasidone Hydrochloride Lurasidone Hydrochloride | $1.07 | $0.3018 | 3.6× | 48 | — | — |
| Alosetron Hydrochloride Alosetron Hydrochloride | $13.83 | $3.92 | 3.5× | 8 | — | — |
| Timoptic in Ocudose Timolol Maleate | $4.85 | $1.38 | 3.5× | 33 | 2,959,342 | $103.4M |
| Prazosin Hydrochloride Prazosin Hydrochloride | $0.2898 | $0.0823 | 3.5× | 42 | — | — |
| Febuxostat febuxostat | $0.7480 | $0.2128 | 3.5× | 37 | 340,761 | $10.8M |
| Dofetilide Dofetilide | $0.6767 | $0.1933 | 3.5× | 21 | 335,875 | $21.1M |
| Felodipine Felodipine | $0.3911 | $0.1117 | 3.5× | 17 | 326,120 | $7.4M |
| Fluoxetine Fluoxetine | $0.1797 | $0.0513 | 3.5× | 36 | — | — |
| Fluphenazine Hydrochloride Fluphenazine Hydrochloride | $0.5872 | $0.1687 | 3.5× | 35 | — | — |
| Clindamycin Phosphate and Benzoyl Peroxide Clindamycin Phosphate and Benzoyl Peroxide | $8.23 | $2.38 | 3.5× | 12 | — | — |
| Ranolazine Ranolazine | $0.5599 | $0.1629 | 3.4× | 45 | 1,248,804 | $56.2M |
| Formoterol fumarate Formoterol fumarate | $4.49 | $1.31 | 3.4× | 15 | 14,457 | $3.7M |
| Lansoprazole Lansoprazole | $0.3657 | $0.1067 | 3.4× | 83 | 1,240,163 | $24.0M |
| Triazolam Triazolam | $1.16 | $0.3397 | 3.4× | 12 | 98,275 | $2.3M |
| Klor-Con potassium chloride | $0.4161 | $0.1232 | 3.4× | 102 | 15,757,243 | $404.8M |
| oxybutynin chloride oxybutynin chloride | $0.3921 | $0.1169 | 3.4× | 46 | 5,421,255 | $112.5M |
| testosterone testosterone | $2.02 | $0.6023 | 3.4× | 44 | 562,711 | $117.7M |
| Cyclosporine cyclosporine | $3.63 | $1.08 | 3.4× | 38 | 2,291,687 | $524.7M |
| Desipramine Hydrochloride desipramine hydrochloride | $0.6264 | $0.1872 | 3.3× | 9 | — | — |
| oxybutynin oxybutynin | $0.2923 | $0.0875 | 3.3× | 6 | 1,434 | $3K |
| Levofloxacin Levofloxacin | $0.3722 | $0.1115 | 3.3× | 51 | 2,499,553 | $5.8M |
| Valganciclovir hydrochloride Valganciclovir hydrochloride | $3.64 | $1.10 | 3.3× | 22 | — | — |
| Sumatriptan Sumatriptan Succinate | $1.10 | $0.3319 | 3.3× | 37 | 1,875,135 | $17.0M |
| Nevirapine Nevirapine | $5.07 | $1.54 | 3.3× | 10 | 11,324 | $2.8M |
| Levorphanol Tartrate Levorphanol Tartrate | $34.92 | $10.65 | 3.3× | 10 | 4,464 | $12.2M |
| Alendronate Sodium Alendronate Sodium | $0.8518 | $0.2598 | 3.3× | 26 | 8,816,583 | $56.5M |
| Zolmitriptan Zolmitriptan | $4.66 | $1.42 | 3.3× | 30 | 53,327 | $2.2M |
| Midodrine Hydrochloride Midodrine Hydrochloride | $0.4798 | $0.1469 | 3.3× | 43 | — | — |
| Ondansetron Hydrochloride Ondansetron Hydrochloride | $0.2871 | $0.0881 | 3.3× | 61 | — | — |
| Ritonavir Ritonavir | $2.15 | $0.6618 | 3.3× | 14 | 51,440 | $3.9M |
| LAMIVUDINE and ZIDOVUDINE LAMIVUDINE and ZIDOVUDINE | $2.25 | $0.6918 | 3.2× | 8 | — | — |
| Levocetirizine Dihydrochloride Levocetirizine Dihydrochloride | $0.1725 | $0.0534 | 3.2× | 68 | 2,327,230 | $16.2M |
| Dexamethasone Dexamethasone | $1.12 | $0.3451 | 3.2× | 59 | 1,477,005 | $56.4M |
| Ondansetron Ondansetron | $0.4107 | $0.1277 | 3.2× | 63 | 4,929,800 | $41.4M |
| Mibelas 24 Fe Norethindrone Acetate, Ethinyl Estradiol And Ferrous Fumarate | $0.8717 | $0.2727 | 3.2× | 1 | — | — |
| Norethindrone Acetate and Ethinyl Estradiol Norethindrone Acetate and Ethinyl Estradiol Tablets and Ferrous Fumarate Tablets | $0.8717 | $0.2727 | 3.2× | 1 | — | — |
| Tolterodine tartrate Tolterodine tartrate | $0.8465 | $0.2660 | 3.2× | 28 | 810,996 | $29.8M |
| Alfuzosin Hydrochloride Alfuzosin Hydrochloride | $0.3466 | $0.1093 | 3.2× | 17 | — | — |
| Glycopyrrolate Glycopyrrolate | $0.5554 | $0.1752 | 3.2× | 75 | 244,823 | $8.5M |
| Paroxetine Paroxetine | $0.2136 | $0.0674 | 3.2× | 35 | — | — |
| Risperidone Risperidone | $0.1622 | $0.0513 | 3.2× | 59 | 3,811,919 | $21.4M |
| Colchicine Colchicine | $0.4063 | $0.1287 | 3.2× | 45 | 1,542,308 | $19.1M |
| Levothyroxine Sodium levothyroxine sodium | $0.1646 | $0.0522 | 3.2× | 64 | 48,650,486 | $373.2M |
| Acitretin Acitretin | $6.70 | $2.14 | 3.1× | 17 | 45,250 | $8.4M |
| Desoximetasone Desoximetasone | $2.24 | $0.7168 | 3.1× | 17 | 46,030 | $4.5M |
| Ciprofloxacin Ciprofloxacin | $0.2748 | $0.0880 | 3.1× | 46 | 2,209 | $49K |
| Hydroxyzine hydrochloride Hydroxyzine hydrochloride | $0.1841 | $0.0596 | 3.1× | 65 | — | — |
| Ezetimibe Ezetimibe | $0.2132 | $0.0691 | 3.1× | 39 | 8,755,353 | $93.7M |
| Ketorolac Tromethamine Ketorolac Tromethamine | $0.5441 | $0.1764 | 3.1× | 78 | 1,683,907 | $4.9M |
| Rivastigmine Tartrate Rivastigmine Tartrate | $0.5051 | $0.1638 | 3.1× | 18 | 355,195 | $9.6M |
| Albendazole Albendazole | $13.41 | $4.36 | 3.1× | 22 | 12,458 | $1.7M |
| Clobetasol Propionate clobetasol propionate | $0.3592 | $0.1172 | 3.1× | 48 | 2,761,530 | $35.8M |
| Lacosamide Lacosamide | $0.6345 | $0.2075 | 3.1× | 80 | 931,819 | $44.4M |
| Torsemide Torsemide | $0.1887 | $0.0621 | 3.0× | 30 | 3,010,513 | $32.8M |
| Paliperidone Paliperidone | $3.77 | $1.24 | 3.0× | 33 | 396,890 | $36.0M |
| Fluocinonide Fluocinonide | $0.6300 | $0.2084 | 3.0× | 31 | 733,992 | $18.0M |
| acyclovir acyclovir | $0.1966 | $0.0651 | 3.0× | 90 | 2,010,220 | $21.2M |
| Escitalopram Escitalopram | $0.1923 | $0.0639 | 3.0× | 34 | — | — |
| Lamotrigine Lamotrigine | $0.8973 | $0.2994 | 3.0× | 65 | 4,397,432 | $231.4M |
| Clobazam Clobazam | $0.6610 | $0.2217 | 3.0× | 27 | 183,581 | $6.2M |
| Omeprazole Omeprazole | $0.1503 | $0.0505 | 3.0× | 161 | 28,883,231 | $216.0M |
| propafenone hydrochloride propafenone hydrochloride | $0.9268 | $0.3112 | 3.0× | 19 | — | — |
| Cromolyn Sodium Cromolyn Sodium | $1.71 | $0.5738 | 3.0× | 25 | 92,713 | $24.4M |
| Fluoxetine Fluoxetine Hydrochloride | $0.6204 | $0.2090 | 3.0× | 59 | — | — |
| Paroxetine Hydrochloride Paroxetine Hydrochloride | $1.27 | $0.4279 | 3.0× | 17 | — | — |
| Voriconazole Voriconazole | $1.42 | $0.4800 | 3.0× | 52 | 37,507 | $2.6M |
| Doxepin Doxepin | $4.03 | $1.36 | 3.0× | 9 | — | — |
| Metoprolol Succinate Metoprolol succinate | $0.1640 | $0.0555 | 3.0× | 65 | 32,295,263 | $277.0M |
| ropinirole hydrochloride ropinirole hydrochloride | $0.2264 | $0.0766 | 3.0× | 15 | — | — |
| Tarina 24 Fe Norethindrone Acetate and Ethinyl Estradiol and Ferrous Fumarate | $0.6010 | $0.2034 | 3.0× | 10 | — | — |
| Tri-VyLibra Lo Norgestimate and Ethinyl Estradiol | $0.3100 | $0.1049 | 3.0× | 17 | — | — |
| Guanfacine extended-release guanfacine | $0.4254 | $0.1441 | 3.0× | 31 | — | — |
| Bisoprolol Fumarate Bisoprolol fumarate | $0.3933 | $0.1333 | 3.0× | 33 | 1,091,996 | $21.8M |
| Mexiletine Hydrochloride Mexiletine Hydrochloride | $0.7814 | $0.2651 | 2.9× | 21 | — | — |
| MethylPREDNISolone methylprednisolone | $0.3309 | $0.1124 | 2.9× | 35 | 5,856,831 | $27.8M |
| Icosapent Ethyl Icosapent Ethyl | $1.03 | $0.3522 | 2.9× | 30 | 2,030,537 | $239.8M |
| Memantine hydrochloride Memantine hydrochloride | $0.9201 | $0.3152 | 2.9× | 55 | — | — |
| montelukast sodium montelukast sodium | $0.1998 | $0.0685 | 2.9× | 42 | 12,473,122 | $107.8M |
| Potassium Citrate Extended Release Potassium Citrate | $0.5233 | $0.1796 | 2.9× | 15 | 530,594 | $28.7M |
| Rosuvastatin Rosuvastatin | $0.1894 | $0.0650 | 2.9× | 20 | — | — |
| Clindamycin Phosphate Clindamycin Phosphate Gel USP, 1% | $0.3948 | $0.1357 | 2.9× | 1 | — | — |
| Allopurinol Allopurinol | $0.1636 | $0.0563 | 2.9× | 61 | 9,710,041 | $85.6M |
| Tretinoin tretinoin | $1.41 | $0.4851 | 2.9× | 45 | 268,282 | $9.7M |
| Adalimumab-adbm Adalimumab-adbm | $1,849.17 | $637.95 | 2.9× | 2 | 8,014 | $22.8M |
| Diclofenac Potassium diclofenac potassium | $15.11 | $5.22 | 2.9× | 50 | 376,449 | $228.1M |
| Duloxetine Duloxetine | $0.2909 | $0.1008 | 2.9× | 41 | — | — |
| Niacin Niacin | $0.4297 | $0.1492 | 2.9× | 16 | 158,434 | $3.9M |
| Tanlor methocarbamol | $23.99 | $8.35 | 2.9× | 77 | 3,191,039 | $3.6B |
| Phenobarbital Phenobarbital | $0.3779 | $0.1317 | 2.9× | 32 | 398,979 | $11.7M |
| Trazodone Hydrochloride Trazodone Hydrochloride | $1.51 | $0.5274 | 2.9× | 49 | — | — |
| Perphenazine Perphenazine | $0.4040 | $0.1413 | 2.9× | 19 | 193,956 | $3.7M |
| Acetazolamide Acetazolamide | $0.3825 | $0.1340 | 2.9× | 45 | 333,080 | $5.9M |
| Riluzole Riluzole | $0.8345 | $0.2945 | 2.8× | 15 | 52,250 | $2.6M |
| Doxylamine Succinate and Pyridoxine Hydrochloride Doxylamine Succinate and Pyridoxine Hydrochloride, Delayed release Tablets 10 mg/10 mg | $3.54 | $1.25 | 2.8× | 2 | — | — |
| Captopril Captopril | $0.3842 | $0.1361 | 2.8× | 17 | 70,928 | $2.2M |
| Fyavolv Norethindrone Acetate and Ethinyl Estradiol | $1.84 | $0.6551 | 2.8× | 12 | — | — |
| Terbinafine Terbinafine Hydrochloride | $0.3771 | $0.1341 | 2.8× | 58 | — | — |
| Oxcarbazepine Oxcarbazepine | $0.3484 | $0.1244 | 2.8× | 63 | 1,288,863 | $31.3M |
| Chlorthalidone Chlorthalidone | $0.2472 | $0.0882 | 2.8× | 46 | 2,944,741 | $32.0M |
| Promethazine Hydrochloride and Phenylephrine Hydrochloride promethazine hydrochloride and phenylephrine hydrochloride | $0.4560 | $0.1632 | 2.8× | 1 | — | — |
| Sacubitril and Valsartan Sacubitril and Valsartan | $1.53 | $0.5485 | 2.8× | 30 | — | — |
ⓘ How this was built
Data sources
- CMS Part D quarterly plan pricing files (negotiated point-of-sale prices across ~5,500 plans)
- CMS NADAC weekly pharmacy acquisition cost survey (data.medicaid.gov)
- FDA NDC Directory (openFDA)
- CMS Part D Spending by Drug (annual utilization)
Method
For each NDC, the median Part D negotiated price across all plans is divided by the NADAC in force in the SAME quarter (comparing against today's NADAC would measure file lag, not spread). One row per molecule — its highest-markup NDC. Drugs with acquisition cost under 5¢/unit are excluded so rounding can't manufacture large ratios. All prices are gross of rebates. "Est. spread / yr" multiplies the per-unit gap by last year's Part D dosage units for the molecule — a labeled estimate, not an audit.
Pipeline and calculations built by Claude (Fable 5) from the public datasets above. Educational only — verify against primary sources before acting.
One row per molecule (its highest-markup NDC). NADAC is matched to the plan file's quarter so file lag can't masquerade as spread. Prices are before rebates — on brands, rebates recover part of the gap for the plan (not for the patient at the counter); on multi-source generics, rebates are small and the gap is mostly real margin. "Est. spread / yr" multiplies the per-unit gap by last year's Part D dosage units for the molecule — a labeled estimate, not an audit. See the methodology.
Part of the bigger story
The spread is one of the gaps middlemen live on — the big picture shows all of them: the seven prices of one pill, the same government paying twice, and where the money actually goes.