ASP is not the best price, but it's certainly not "terrible". It's the average price including all discounts offered to private insurers.
The 42% of AWP that the VA pays sounds awesome, but AWP is inflated (typically 20-40% more than list price).
At any rate, yes, you are correct, the big four (DOD, BOIA, DOC and one I can't remember) get very discounted prices. However, they can also exercise a lot of control over what patients get without having to hear a lot of complaints. For example, the DOC is not using Sovaldi all that much, but if prisoners complain, not much is done.
Now imagine if Medicare said "no, too expensive, we're not paying for that drug". Congressmen would be getting hundreds of calls from seniors and the AARP about denying the elderly population the latest and greatest drugs.
The 42% of AWP that the VA pays sounds awesome, but AWP is inflated (typically 20-40% more than list price).
At any rate, yes, you are correct, the big four (DOD, BOIA, DOC and one I can't remember) get very discounted prices. However, they can also exercise a lot of control over what patients get without having to hear a lot of complaints. For example, the DOC is not using Sovaldi all that much, but if prisoners complain, not much is done.
Now imagine if Medicare said "no, too expensive, we're not paying for that drug". Congressmen would be getting hundreds of calls from seniors and the AARP about denying the elderly population the latest and greatest drugs.