In progressVideo · 18 min
The Gross-to-Net Waterfall
List price is a starting fiction. This is the sequence of concessions that produces the number a manufacturer actually keeps.
WAC is the list. Chargebacks, rebates, copay support, 340B, and returns sit under it. By the time a brand’s net price is reported, several of those lines have moved, and they have not moved in the same direction for every channel.
The waterfall is how access, 340B, and PBM teams talk to each other without using three different numbers for the same SKU. Walk it once with a preferred brand and once with an excluded one — the shape changes.
Key takeaways
- WAC is not net
- Each concession has a counterparty
- Channel mix moves the waterfall