Solving the Gross-to-Net Bubble With Better Data

Today’s guest post comes from Angie Franks, CEO at Kalderos.

Angie examines how data fragmentation contributes to inefficiencies in drug discount programs and the broader gross-to-net bubble—the widening difference between a drug’s revenue at list prices and what manufacturers actually receive. Angie outlines how better access to consistent, claims-level data could help reduce waste, improve program integrity, and enhance collaboration among stakeholders in the drug channel.

To learn more, download Following the Dollars: Why 340B Reform Is a Data-Driven Necessity.

Read on for Angie’s insights.

Solving the Gross-to-Net Bubble With Better Data
By Angie Franks, CEO, Kalderos

The gross-to-net bubble—the growing gap between manufacturers' revenues at the list price of drugs and what manufacturers receive after discounts and rebates—reached an estimated $356 billion in 2024, as reported on Drug Channels. While growth has slowed in recent years, the bubble continues to expand, raising critical questions about where these discounts ultimately go and who benefits.

Discounting is not inherently problematic. It’s a common business practice across many industries and is used to incentivize access, align pricing with value, or meet market requirements. But in healthcare, and prescription drugs in particular, opacity makes it nearly impossible to follow the discount dollar. The intended beneficiaries for many of these discounts, namely patients and plan sponsors, often don’t see the full value passed through. This contributes to high out-of-pocket costs, distorted incentives, and reduced trust across the healthcare system.

Behind the complexity lies a persistent issue: fragmented and siloed data. Manufacturers, covered entities, PBMs, and payers often operate with only a partial view. It’s not always clear whether a discount has already been applied or whether the entity receiving the discount is eligible. In some cases, multiple discounts may be applied to the same prescription, a challenge often referred to as duplicate discounting.

Consider the 340B Drug Pricing Program. Some industry estimates suggest that as much as 3% of total discounts, or roughly $11 billion, may be lost to duplicate claims or improper discounting practices. These aren’t just accounting errors, they represent dollars that could otherwise go toward patient care, R&D, or reducing drug costs system-wide.

Transparency as a Lever for Efficiency

Improving transparency doesn’t require overhauling the system. It starts with sharing better data, particularly claims-level data. Claims data creates a common language that can bring clarity to a fragmented system, helping stakeholders understand where drugs are dispensed or administered, to whom they are administered, and under what coverage.

This level of visibility is particularly important in high-volume programs, such as Medicaid and 340B, which together account for roughly one-third of the gross-to-net gap. While program rules differ, the underlying challenge is consistent: without a shared, data-driven understanding of what discounts have already been applied, waste and conflict are inevitable.

Good-faith inquiries are a start, and many stakeholders use them today to confirm anomalous activity and resolve issues, but there is a better, less-resource intense option. Claims data enables a more comprehensive and consistent approach, reducing manual friction, improving program integrity, and helping ensure that discounts reach their intended targets.

A Shared Interest in Sustainability

This isn’t just a manufacturer problem. Covered entities, providers, and payers all have a vested interest in maintaining the integrity and sustainability of discount programs. As the costs of delivering care continue to rise, and as investment dollars are stretched across everything from new therapies to patient assistance programs, reducing inefficiency is a shared imperative.

When stakeholders work from a single, verified data set, disputes decrease, and trust increases. Sharing claims data establishes a foundation for collaboration, rather than confrontation. It helps shift the focus away from compliance policing and toward shared value creation. It results in lower costs, increased access, and a stronger overall health system.

Importantly, courts have affirmed that manufacturers may require reasonable claims data as a condition for extending discounts under the 340B program. But mandates alone aren’t the answer. Voluntary, collaborative data sharing is more likely to build durable partnerships and make a measurable impact on waste.

A Platform for Progress

At Kalderos, we believe solving the gross-to-net challenge starts with transparency, not blame. Our platform, Truzo, was purpose-built to manage the complexity of drug discount compliance by enabling manufacturers, providers, and government programs to work from a shared source of truth.

By supporting the secure exchange of claims data, Truzo helps uncover hidden waste, reduce duplicate discounts, and ensure that discounts reach the patients and payers they were intended to benefit. It’s a step toward a smarter, more efficient drug pricing system and a future where every stakeholder can win.

To learn how Truzo can help reduce waste and build trust across the drug discount ecosystem, download our whitepaper, Following the Dollars: Why 340B Reform Is a Data-Driven Necessity.

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