Investor Presentaiton
Overall, our analysis shows pharmacy reimbursements vary significantly between drugs, pharmacy
type, and PBM, as shown in Figures 14, 15, and 16. Pharmacies often lose money when filling certain
prescriptions and pharmacists have reported patients are sometimes turned away if a prescription will
cost the pharmacy too much money. In 2021, pharmacies dispensed over 12,000 acetaminophen
(Tylenol) prescriptions and, on average, made only $0.35 on each prescription. Pharmacies also
dispensed almost 71,000 albuterol sulfate prescriptions with a total estimated loss of over $1.3 million
or about $19 lost per prescription filled. Albuterol sulfate is an important lifesaving drug used to treat
breathing conditions due to asthma and allergies and is one of the most commonly dispensed
medications in Medicaid.
The Asthma and Allergy Foundation of America encourages states to adopt policies that promote access to
life saving medicine such as albuterol sulfate.
Drug
Estimated total
Figure 14: Pharmacy reimbursements vary widely between selected prescription drugs in 2021
Dollar amount
Estimated average pharmacy
tested
profit/loss per claim
Number of
claims tested
pharmacy
profit/loss
Acetaminophen
12,178
$28,349
$4,269
$0.35
(Tylenol)
Albuterol Sulfate
70,955
$2,766,642
-$1,315,643
-$18.54
Amoxicillin
13,608
$51,462
$35,067
$2.58
Basaglar
45,767
$16,790,230
$219,619
$4.80
Biktarvy
6,195
$20,369,308
$192,792
$31.12
Budesonide and
14,924
$4,079,910
$865,952
$58.02
Formoterol
Fumarate Dihydrate
Buprenorphine and
26,101
$3,766,875
$1,238,829
$47.46
Naloxone
Eliquis
Flovent
Humira
Metformin
Omeprazole
Trulicity
Total
17,743
$8,457,352
$48,779
$2.75
12,868
$3,357,669
$56,127
$4.36
3,947
$26,178,519
$25,836
$6.55
26,184
$124,781
$62,680
$2.39
47,812
$176,185
$117,167
$2.45
18,473
$15,267,881
$716,139
$38.77
316,755
$101,415,163
$2,267,613
Source: Auditor analysis of OHA and PBM 2021 claims data and Oregon average acquisition cost data
Potential monopoly power may be putting patients and independent
pharmacies at risk
Pharmacies made profits on certain drugs, but those amounts vary widely and likely do not cover the
operating and overhead expenses incurred by the pharmacy. We found local, independent pharmacies
are more likely to be reimbursed less for prescriptions than national chain pharmacies. Figure 16
highlights the reimbursement disparity between pharmacy type and some name brand drugs per
prescription, like Humira and Biktarvy. For both drugs, the estimated profits for national chain
pharmacies are more than three times the amount that independent pharmacies made.
Oregon Secretary of State Report 2023-25 | August 2023 | page 21View entire presentation