29 pages. "Between 2014 and 2018, per-person spending grew at an average annual rate of 4.3%, climbing to $5,892.... That rise outpaced growth in per-capita GDP, which increased at an average rate of 3.4% over the same period.... Data from Massachusetts shows that for those with commercial insurance the percentage of gross pharmacy spending accounted for by rebates grew from 6.5% in 2014 to 15.6% in 2018. Applying these figures to our data, we find that spending per person declined from an average annual rate of 4.3% to an average annual rate of 3.8% between 2014 and 2018."