Econ Papers Daily / 期刊论文
费舍尔-舒尔茨讲座：药品目录与回扣的合同设计
Fisher–Schultz Lecture: Contracting Over Pharmaceutical Formularies and Rebates
摘要
We investigate how formularies used by pharmacy benefit managers (PBMs) affect equilibrium manufacturer rebates for branded drugs through tiering and exclusion. We develop a theoretical model of multidimensional contracting in which a PBM negotiates with drug manufacturers over menus of formulary‐contingent rebates and chooses a formulary. We then estimate consumer demand responses to tier placement for statins using claims data from Princeton University, a large employer contracting with a single PBM to offer prescription drug coverage to its employees. Combining the theoretical model with demand estimates and observed list prices, we quantify how allowing for differential tier placement and exclusion affect equilibrium rebates. Our predictions are consistent with available aggregate rebate data, and we find that allowing a PBM to place branded drugs on preferred‐ and non‐preferred tiers can substantially increase negotiated rebate payments.
中文摘要
我们研究了药房福利管理者（PBMs）所使用的处方集如何通过分级和排除机制影响品牌药品的制造商回扣均衡。我们构建了一个多维契约理论模型，其中PBM与药品制造商就一系列基于处方集的回扣菜单进行谈判，并选择处方集。随后，我们利用普林斯顿大学的索赔数据，估计了消费者对汀类药物分级安置的需求反应，普林斯顿大学是一家与单一PBM签约、为其员工提供处方药覆盖的大型雇主。结合理论模型、需求估计及观察到的标价，我们量化了允许差异化分级安置和排除对均衡回扣的影响。我们的预测与可获得的总体回扣数据一致，并发现允许PBM将品牌药品置于优选和非优选层级可显著增加谈判达成的回扣支付。