The current economic dynamics of the U.S. pharmaceutical market have produced a situation in which all pharmacies—whether big chains like CVS, large retailers with pharmacies like Wal-Mart or grocery stores, or independent mom-and-pop pharmacies— sell on-patent drugs at little or no mark-up. Virtually all of their profits come from their mark-ups on generic drugs, plus any mark-ups on whatever else they sell in the store.
Thus, the effect of what Wal-Mart is doing is to lower the prices consumers pay by cutting its own profit margin on the products. It’s the same basic business strategy Wal-Mart has applied to everything else it sells—low per-unit profits, compensated for by high unit sales volume. The effects on Wal-Mart's competitors are the same—to compete on price they have to match Wal-Mart's volume, but to compete on volume they have to match Wal-Mart's prices.
The underlying economics of pharmaceutical markets that make generics the source of retail pharmacy profits can be illustrated with the following example:
Assume there are several branded products in a particular class of drugs, for instance statin drugs for lowering cholesterol. They all cost hundreds of millions of dollars to develop, test and bring to market, but pennies a pill to produce. So, let's assume their makers each sell them at about $100 for a 30 day supply. The innovator companies are using the mark-up to recoup their enormous up-front investment. They can do so because their patents prevent, for a limited time, anyone else from making and selling the drugs.
Because of the drugs' high wholesale price, there is little room for pharmacies to charge customers extra for dispensing the pills. The only way for pharmacies to get a better deal for their customers is to negotiate a better deal from the manufacturer, often a cut or rebate off the wholesale price, usually in exchange for higher sales volume. Most pharmacies don't have the volume to do that.
However, because of the similarities among drugs in any given class, it is possible for many, though not all, patients that two or more of the drugs in a class will work equally well. Thus, despite the monopoly rights granted each manufacturer, and even if all drugs in a particular class are still on-patent, some level of competition does exist, and manufacturers are willing to pay (through various forms of wholesale discounts) to have patients switched to their drug. Pharmacy benefit managers (PBMs) came into existence based on a business model for applying expertise at exploiting this opportunity for price competition between on-patent drugs on a large scale.
When one or two of those drugs go off-patent, generic companies can legally make and sell them. Like the original manufacturer they can make the drugs for pennies a pill, but they have a much smaller up-front investment to recoup. Thus, the wholesale prices for generics will be much closer to the marginal production costs. This will particularly be the case if two or more generic companies make the same drug, since competition between them prevents either from raising prices.
Now, pharmacies can buy the generic drugs wholesale at much lower prices. For purposes of the example, lets say that the wholesale price to the pharmacy for a 30 day supply of the generic is $5.
Now comes the fun part. The reference price in the mind of the customer, either individuals or a third-party like the employer or the insurer, is not the wholesale price of the generic, but rather the retail price of the on-patent drugs. So, if the pharmacy charges, say, $20 for the generic, that represents an 80 percent saving off any alternatives that are still on-patent. To the customer, that looks like a very good deal. But, it is also a 400 percent mark-up for the pharmacy over the wholesale price it paid for the generic.
Thus, pharmacies can keep their retail prices for on-patent drugs down close to their wholesale acquisition cost for those products, and offer much cheaper generic alternatives (both of which please their customers), while still making a profit out of their high (in percentage terms) mark-ups on generics.
Another piece of data helps to further illustrate these economics: Today in the U.S., half of all prescriptions are filled with generics, but that half represents only 10 percent of total spending on drugs.
Clearly, innovative drug makers could never afford to develop new drugs if all they could charge were generic prices. So, one can infer that about 90 percent of total current drug spending supports the research and development of new drugs—through not only direct R&D spending but also the associated sales and marketing costs of on-patent products and, yes, the high shareholder returns and salaries needed to attract big investment and top talent to the very high risk business of pushing ever forward the frontiers of medical science.
In contrast, if pharmacies can mark-up half the prescriptions they fill (the generics) by $5, $10, or $15 each, they can comfortably afford to make no profit whatsoever on the other half of the prescriptions they fill (on-patent drugs).
This works just fine until one of the pharmacies decides to cut its own profits from generics, in order to attract customers away from competing pharmacies—figuring it can make up the difference out of higher sales volume. That is what Wal-Mart just initiated.