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A primer on the economics of prescription pharmaceutical pricing in health insurance markets

Author: Ernst R Berndt; Thomas G McGuire; Joseph P Newhouse; National Bureau of Economic Research.
Publisher: Cambridge, Mass. : National Bureau of Economic Research, ©2011.
Series: Working paper series (National Bureau of Economic Research), no. 16879.
Edition/Format:   eBook : Document : EnglishView all editions and formats
Summary:
The pricing of medical products and services in the U.S. is notoriously complex. In health care, supply prices (those received by the manufacturer) are distinct from demand prices (those paid by the patient) due to health insurance. The insurer, in designing the benefit, decides what prices patients pay out-of-pocket for drugs and other products. In this primer we characterize cost and supply conditions in markets  Read more...
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Details

Material Type: Document, Internet resource
Document Type: Internet Resource, Computer File
All Authors / Contributors: Ernst R Berndt; Thomas G McGuire; Joseph P Newhouse; National Bureau of Economic Research.
OCLC Number: 707921939
Notes: "March 2011."
Title from http://www.nber.org/papers/16879 viewed Mar. 21, 2011.
Description: 1 online resource (39 pages) : illustrations.
Series Title: Working paper series (National Bureau of Economic Research), no. 16879.
Responsibility: Ernst R. Berndt, Thomas G. McGuire, Joseph P. Newhouse.

Abstract:

The pricing of medical products and services in the U.S. is notoriously complex. In health care, supply prices (those received by the manufacturer) are distinct from demand prices (those paid by the patient) due to health insurance. The insurer, in designing the benefit, decides what prices patients pay out-of-pocket for drugs and other products. In this primer we characterize cost and supply conditions in markets for generic and branded drugs, and apply basic tools of microeconomics to describe how an insurer, acting on behalf of its enrollees, would set demand prices for drugs. Importantly, we show how the market structure on the supply side, characterized alternatively by monopoly (unique brands), Bertrand differentiated product markets (therapeutic competition), and competition (generics), influences the insurer's choices about demand prices. This perspective sheds light on the choice of coinsurance versus copayments, the structure of tiered formularies, and developments in the retail market.

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