Published: 25 June 2024| Version 2 | DOI: 10.17632/5dp6hwckj5.2
Naiem Issa, Christopher Bunick


Supplemental Table 1. Comparison of wholesale acquisition (WAC) and patient costs of clascoterone and sarecycline with other acne therapies. WAC info is publicly available and represents the cost wholesaler pays to manufacturer (data collected as of April 2024). WAC is not the same as “ASP”; ASP is the price the pharmacy pays for the medication from the wholesaler. Payment adjudication happens after they dispense to the patient. Covered: the process is only pertinent to "covered" prescriptions; when a Rx goes through covered the following fees are taken out of the WAC of each prescription (amount depends on contract negotiations: rebates to PBM/insurance for a branded drug in dermatology ranges from 50% of WAC to 80% of WAC in addition to other standard fees: returns, savings cards, e-vouchers, rebates, wholesaler fees, prompt pay). Uncovered: more often than not, in dermatology, when a medication is not covered, the manufacturer bypasses the wholesaler and the only income to the manufacturer is the co-pay the patient pays minus a dispensing fee & COGs (cost of goods). Distribution = manufacturer to pharmacy; pharmacy to patient. Cash Flow = uncovered copay from patient to pharmacy, pharmacy keeps dispensing fee, remaining to manufacturer (pharma company). Prior Authorizations (PAs): the overall Rx process without submitting a PA hurts the coverage of the medication because payors do not see this volume coming through. Payors want enough volume to make it worth paying for. Not filing PAs hurts the coverage of the dermatology specialty. Without them, drug coverage will not get better and the only remaining option is to increase the list price of the drug. CoPay – information in Table came from several common specialty pharmacies; however, co-pay depends on partnerships between manufacturers and pharmacies. a must be filled at PhilRx for $90 offer b off label use requires prior authorization and does not guarantee coverage