Econ Papers Daily / 期刊论文
对凯特·何与罗宾·李《费舍尔-舒尔茨讲座：药品目录与返利合同》的评论
Comment on ‘Fisher–Schultz Lecture: Contracting Over Pharmaceutical Formularies and Rebates’ by Kate Ho and Robin Lee
摘要
Biopharmaceuticals advance health and economic growth. Unlike central bargaining abroad, the United States uses private firms, pharmacy benefit managers (PBMs), to manage medicine access and spending. Yet, PBMs' roles in advancing efficiency are understudied. Ho and Lee model PBMs' use of tiered formularies, lists of covered medicines, without the use of proprietary data on the price concessions drug makers offer for preferred placement. They find PBMs' use of tiered formularies generate significant payor savings through competition. Complementing Ho and Lee, Feng and Maini (2024) model how patient demand inertia limits PBMs' ability to extract price concessions from drug makers which consequently erodes the efficacy gains of PBM formularies. Conti, Frandsen, Powell, and Rebitzer (2021) model formulary auctions where PBM size drives payor savings, but also spurs endogenously set high list prices, reducing patient access. Future economic research should focus on PBM market entry and vertical integration, pharmacy steering, and effects on innovation.
中文摘要
生物制药推动健康与经济增长。与国外集中谈判不同，美国依靠私营企业——药品福利管理者（PBMs）来管理药品获取与支出。然而，关于PBMs在提升效率方面的作用研究尚不充分。Ho和Lee构建了PBMs使用分级处方集（即承保药品清单）的模型，而未利用药企为获得优先地位而提供的价格优惠专有数据。他们发现，PBMs通过分级处方集的使用，借助竞争机制为支付方带来了显著的成本节省。作为对Ho和Lee研究的补充，Feng和Maini（2024）建模分析了患者需求惯性如何限制PBMs从药企获取价格优惠的能力，进而削弱了PBM处方集的效率收益。Conti、Frandsen、Powell和Rebitzer（2021）则对处方集拍卖进行了建模，指出PBM规模虽能驱动支付方节省成本，但也促使药企内生地设定高昂标价，从而降低了患者的药品可及性。未来经济研究应聚焦于PBM市场进入与纵向整合、药房引导行为及其对创新的影响。