Please help me understand/solve this US Healthcare Pricing problem. 
Assumptions: 1. Manufacturer List Price is $3.25/tablet for Brand E, 60 tablets/bottle 2. Tablet is taken twice/day; Product is on Tier 2 for Managed Care/PBM and Tier 3 for Medicare 3. Co-Pays for Managed Care/PBM are $5 Tier 1, $25 Tier 2, $40 Tier 3, Coinsurance 25% Tier 4 Co-Pays for Medicare are $3 Tier 1, $15 Tier 2, $35 Tier 3, Coinsurance 20% Tier 4 4. 5. Medicare Part D Plans gets a 30% rebate for Tier 2; 20% for Tier 3; 0% for Tier 4 when not in the donut hole a. Manufacturers provide a 50% discount on brand-name drugs when in the donut hole 6. PHS Hospital is given highest price that is still nominal 7. Cash Paying customer pays AWP +5% 8. Wholesaler pays list price after 30 days 9. Managed Care and VA/Military are considered equivalent plans 10. Medicaid & FSS has no CPI penalty 11. MediCal, California controlled Medicaid gets a 10% supplemental rebate for Tier 2 and 3 12. Managed Care/PBM reimburses brand to pharmacy at AWP -10% 13. Managed Care/PBM gets the following rebate from the manufacturer: 15% rebate for Tier 2 5% rebate for Tier 3 C. 0% rebate for Tier 4 a. b. Cascade Current List Price per bottle Medicare Price in Donut Hole Paid to Pharma Manufacturer Managed Care Price Paid to Pharma Manufacturer Medicaid Price FSS Price Best Medicaid Price PHS Nominal Price Managed Care Patient Pays What? Medicare Co-Pay Initially Is What? Price % Difference vs List Price Explanation Assumptions: 1. Manufacturer List Price is $3.25/tablet for Brand E, 60 tablets/bottle 2. Tablet is taken twice/day; Product is on Tier 2 for Managed Care/PBM and Tier 3 for Medicare 3. Co-Pays for Managed Care/PBM are $5 Tier 1, $25 Tier 2, $40 Tier 3, Coinsurance 25% Tier 4 Co-Pays for Medicare are $3 Tier 1, $15 Tier 2, $35 Tier 3, Coinsurance 20% Tier 4 4. 5. Medicare Part D Plans gets a 30% rebate for Tier 2; 20% for Tier 3; 0% for Tier 4 when not in the donut hole a. Manufacturers provide a 50% discount on brand-name drugs when in the donut hole 6. PHS Hospital is given highest price that is still nominal 7. Cash Paying customer pays AWP +5% 8. Wholesaler pays list price after 30 days 9. Managed Care and VA/Military are considered equivalent plans 10. Medicaid & FSS has no CPI penalty 11. MediCal, California controlled Medicaid gets a 10% supplemental rebate for Tier 2 and 3 12. Managed Care/PBM reimburses brand to pharmacy at AWP -10% 13. Managed Care/PBM gets the following rebate from the manufacturer: 15% rebate for Tier 2 5% rebate for Tier 3 C. 0% rebate for Tier 4 a. b. Cascade Current List Price per bottle Medicare Price in Donut Hole Paid to Pharma Manufacturer Managed Care Price Paid to Pharma Manufacturer Medicaid Price FSS Price Best Medicaid Price PHS Nominal Price Managed Care Patient Pays What? Medicare Co-Pay Initially Is What? Price % Difference vs List Price Explanation
