With this penalty in place, even the most minor fluctuations in the price of a generic drug can trigger a penalty. The top 100 Part D generic drugs are priced on average at 10 cents per dose. A simple increase by 1 cent to 11 cents per dose would exceed inflation and trigger the penalty. Conversely, the top 200 brand drugs have an annual average cost of more than $5,800, where an increase of $100 would not trigger a penalty. Further, in many situations, generic manufacturers are now paying penalties in situations that are often outside of their control due to how the penalty is calculated, including when a drug’s price did not increase or even decreased. Many of these low-cost generics are among the most vulnerable to drug shortages.