1 trillion a year on U.S. Pharma

Would drug cost expenditures reports include insurance costs? Or any money that doesn’t go directly into drugs?

I expect they would include pharmacies, drug wholesalers–and pharmacy benefit managers–which handle drugs for insurance companies.

Looking at OECD data - Health resources - Pharmaceutical spending - OECD Data - and picking U$ per capita shows the relative costs with USA well ahead of everyone else.

The explanatory notes say:

Definition of Pharmaceutical spending

Pharmaceutical spending covers expenditure on prescription medicines and self-medication, often referred to as over-the-counter products. In some countries, other medical non-durable goods are also included. Pharmaceuticals consumed in hospitals and other health care settings are excluded. Final expenditure on pharmaceuticals includes wholesale and retail margins and value-added tax. Total pharmaceutical spending refers in most countries to “net” spending, i.e. adjusted for possible rebates payable by manufacturers, wholesalers or pharmacies. This indicator is measured as a share of total health spending, in USD per capita (using economy-wide PPPs) and as a share of GDP.

I assume what they are saying is if you take a drug (except where it’s given in the hospital) the retail cost of that drug counts, whether you paid for all or part of it, and includes the part that insurance covered. If Joe has to pay $600 for his insulin, but Bob pays $50 and his insurance pays $550, it still $600 spent on drugs in each case.

it’s not clear how they’d count Sally, who cannot afford the drugs and has no coverage so she gets that special pharam deal of only $25. I would presume they would count it as $25.

the point is, it’s the end uer cost - not for example, what you paid for the drug to the pharmacy, plus what the pharmacy paid the wholesaler, plus what the wholesaler paid the manufacturer of the drug. That sort of statistic is meaningless. Why they exclude hospitals etc. is not clear unless they perhaps also report a different statistic - “over all what do hospital stays cost”? In that case, “total health spending” would include “what did you pay the pharmacy?” and “what did you pay doctors?” and “what did you pay hospitals?” (where all these numbers also include what insurance also paid that otherwise you would have had to).