Pharmaceutical distributors make money by charging manufacturers a percentage of the wholesale acquisition cost (WAC) of their products, or list price, for distribution services. This is done by buying products from manufacturers at list price and then selling them to customers at the same rate. In certain cases, such as limited-distribution drugs, pharmaceutical distributors may be able to earn some income from selling at a higher price than they bought, such as buying from WAC minus 5 percent and selling to WAC minus 3 percent. For example, if large wholesalers have shortages of specific generic drugs in their supply centers, smaller “gray” wholesalers can sell their inventory of these drugs at a higher price, thus increasing prescription drug costs. Wholesalers can also ensure that a specific volume of generic drugs is distributed to the manufacturer in exchange for the manufacturer selling at lower prices to the wholesaler.
This has led to more drugs bypassing traditional wholesale distribution channels (8% in 201), with specialty drugs comprising the majority of these cases. Generic drug manufacturers compete with each other for contracts with the three major wholesalers, which can put wholesalers in a position to set prices and create a market for generic drugs. Sometimes, consumers pay more for a prescription than for the insurer's cost of purchasing the drug, a common experience with high-deductible health plans. Wholesalers purchase drugs from brand-name manufacturers on WAC minus a negotiated discount, which is kept confidential. Members who have not exhausted their deductible pay the total average wholesale price of 8 for drugs out of pocket, although the plan purchases them at a discount and collects reimbursement from the partner manufacturer.
Despite recent reports of triple-digit price increases for certain drugs, increased public scrutiny has slowed the average rate of list price increases. Contractual agreements under which wholesalers purchase the entire supply of a drug from a single manufacturer can also leave wholesalers vulnerable to manufacturing interruptions.