FWIW, Nova Nordisk claims they are the ones getting screwed in the US because the lion’s share of the profits are consumed by insurance companies and PBMs.
I’ve tried to confirm this but they don’t break out revenues like that. At least not that I can find.
That’s likely true. Big US Pharma companies make the same complaint, but as you said, there’s no transparency in the pricing and discounts. It’s impossible to discern who’s telling the truth.
All the big insurers have captive PBMs today, so they’re the same entity.
There is supposedly a move afoot to force the insurance companies to divest their PBMs, but, with all rules and regs passing through the hands of TIG, can’t help but wonder if the divestiture reg will, somehow, get lost in the shuffle, and never approved.