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Ed Silverman, a senior writer and Pharmalot columnist at STAT, has been covering the pharmaceutical industry for nearly three decades. He is also the author of the morning Pharmalittle newsletter and the afternoon Pharmalot newsletter.

Four months ago, a small pharmaceuticals company bought a medicine used to combat a rare growth disorder in children and quickly raised the list price by 150%.

Such a dramatic boost — from $5,882 to $14,705 per vial — is the sort of move that often draws attention at a time when many Americans complain about rising drug costs. But the company, Eton Pharmaceuticals, argues there is no other way to keep its treatment on the market and make a profit. But its decision involves a calculated twist: a willingness to take a hefty loss on each Medicaid patient.

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The gambit was prompted by the penalties that companies must pay to Medicaid when they raise the price of a medicine above the inflation rate, a consequence of a provision in a federal law that went into effect in early 2024. Thanks to the American Rescue Plan Act, pharmaceutical companies are now required to pay that difference in the form of a rebate to the government health care program.

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