Methodology

The Mispricing Index (PMI)

PMI is a single number from 0 to 100 that expresses how much cheaper a molecule is internationally compared to its US private-pay price.

PMI = ((US_private_pay - international_price) / US_private_pay) * 100

A PMI of 90 means the molecule trades internationally at 10 percent of the US private-pay rate. A PMI of 50 means the international price is half of the US price.

Why the gap is this wide

Our PMI values frequently exceed 90, meaning US retail can be 10x to 100x the international generic price for the same molecule. This is not a calculation error. It reflects four real markup layers between manufacturer cost and US private-pay price.

  1. Wholesaler margin. AmerisourceBergen, McKesson, and Cardinal Health add roughly 2 to 5 percent on most products distributed to US pharmacies.
  2. Pharmacy retail markup. US chain pharmacies (Walgreens, CVS, Rite Aid) typically apply 30 to 80 percent cash-pay markup on top of wholesale cost.
  3. PBM rebate cycle. For insurance-priced products, manufacturer-to-PBM-to-insurer rebates inflate the list price. Cash-pay buyers without insurance pay close to the inflated list, not the net rebate-adjusted price.
  4. Telehealth and specialty markup. When a generic is sold through a US telehealth subscription (Hims, Roman, Keeps, Hers) or specialty channel, consultation and convenience fees are bundled into per-tablet pricing. This can add 10x to 30x on small generics like sildenafil or finasteride.

International licensed pharmacies operate at 2 to 5 percent net margin on the same manufactured product, often the same factory and same INN, without these four markup layers. Compounded together, the gap is typically 80 percent or higher, not 30 to 50 percent.

The PMI numbers in our table are not promotional or selective. They reflect the arithmetic difference between US private-pay retail and international generic retail for the same molecule.

US private-pay source

We use publicly available US cash-pay prices, primarily GoodRx coupon prices, Walgreens.com and CVS.com cash quotes, NADAC (National Average Drug Acquisition Cost from CMS), and manufacturer WAC (Wholesale Acquisition Cost) for branded products. The number reflects what an uninsured consumer would pay at a US retail pharmacy.

International source

The international price is sourced from licensed pharmacy catalogs in jurisdictions such as Singapore (HSA-regulated) and India (CDSCO-regulated wholesale). Catalogs publish their pricing publicly through APIs and structured data feeds. The data reflects the retail dispensing price under the licensing authority of those jurisdictions.

Scope and exclusions

We track off-patent generic molecules where bioequivalent versions exist internationally. We do not track patented brand drugs without an off-patent generic equivalent, since those are not freely available as generics. We do not track biologics that require cold-chain handling. We do not track Schedule II controlled substances (US methylphenidate, amphetamines).

Updates

The index updates monthly. The on-site table reflects the most recent verified pricing from public sources.