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More than two dozen big buyers of prescription medicines expect that prices will rise by an average of 7% annually over the next three years, a slight uptick from a year ago. And 38% believe that a “substantial portion” or three quarters, of the anticipated increases can be attributed to a shift to higher-priced, newer therapies, up sharply from 13% a year ago, according to a new survey.

Interestingly, projections for price hikes over the next three years are actually flat on a weighted average basis, which represents a reversal in a decades-long trend. But there is a caveat. This change is driven primarily by just one respondent — a very large purchaser that is effectively an outlier.

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“Clearly, there is some uncertainty,” wrote Cowen analysts, who queried 26 hospitals, pharmacy benefit managers, and health maintenance organizations that purchased more than $52 billion in medicines in 2018, or more than one-fifth of U.S. retail drug purchases.

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