{"spread_calculation":{"formula":"spread_pct = (Part D avg cost per unit - NADAC per unit) / Part D avg cost per unit × 100","description":"Spread is the difference between what a payer (Medicare Part D) reimburses per unit and the pharmacy acquisition cost (NADAC). A higher spread means more margin captured by intermediaries (PBMs, pharmacies) between the drug's acquisition cost and the reimbursement price.","sources":[{"name":"NADAC (National Average Drug Acquisition Cost)","url":"https://data.medicaid.gov","description":"CMS survey of retail pharmacy acquisition costs, updated weekly"},{"name":"Medicare Part D Spending by Drug","url":"https://data.cms.gov","description":"Annual aggregate spending, utilization, and cost-per-unit data for Part D drugs"}],"limitations":["NADAC reflects retail pharmacy acquisition costs — actual PBM-negotiated prices may differ","Part D cost per unit is a weighted average across all plans and formulations","Spread percentages are approximate indicators, not exact PBM contract margins","Data year lag: Part D data is from most recent published year (currently 2023)"]},"employer_cost_model":{"formula":"estimated_cost = employees × utilization_rate × avg_spend_per_beneficiary","utilization_rate":"Part D beneficiaries using drug / ~50M total Part D beneficiaries","spread_cost":"estimated_cost × (spread_pct / 100)","description":"Estimates what an employer with N employees would spend on a drug class, using Medicare Part D utilization as a proxy. Part D covers ~50M beneficiaries (age 65+), so employer populations (typically younger) may have different utilization patterns.","assumptions":["Employee utilization rates approximate Part D utilization rates","Working-age populations may use some drug classes at different rates than Medicare beneficiaries","Model does not account for employer-specific formulary design, copay structures, or PBM rebates","All spending figures are pre-rebate — actual employer costs may be lower after rebates"]},"data_freshness":{"nadac":"Updated weekly by CMS. Worker queries most recent data on each request (cached 24h).","part_d":"Published annually by CMS. Most recent available year: 2023.","pipeline":"ClinicalTrials.gov data is live. Worker queries on each request (cached 12h).","drug_identity":"openFDA NDC database. Updated continuously (cached 24h)."},"_meta":{"status":"ok"}}