The Impact of Medicaid Reimbursement Policies on Pharmaceutical Spending

医疗补助报销政策对药品支出的影响

• 批准号: 8511406
• 负责人: Abby Elizabeth Alpert
• 金额: $ 9.84万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8511406
• 关键词: Impact; Medicaid; Reimbursement; Policies; Pharmaceutical

DESCRIPTION (provided by applicant): The growing presence of public and private insurers as purchasers of drugs may have distortionary effects on generic drug prices and pharmaceutical spending. Insurer reimbursement rules change the incentives for how pharmacies purchase generic drugs. In particular, reimbursement rules provide incentives for pharmacies to purchase higher priced versions of generic drugs, inducing generic manufacturers to compete for pharmacy market share by setting higher prices than their competitors. While this has important implications for pharmaceutical spending, there are no studies that systematically or quantitatively analyze these effects. The proposed research will investigate the distortionary effects of Medicaid drug reimbursement policies on generic drug prices, spending, and pharmacy purchasing. More specifically, the project will study the pharmacy and manufacturer responses to a unique policy intervention that caused a sharp decline in price for a well-defined set of generic drugs. Prior to the policy, very large differentals between Medicaid reimbursement rates and actual pharmacy purchase prices existed for many of these generic drugs. This "natural experiment" provides an opportunity to study the extent to which Medicaid reimbursement policies distort provider and manufacturer behaviors. The project will use Medicaid State Drug Utilization data from CMS for 1994-2004 which tracks drug utilization at the level of the National Drug Code (NDC) for the universe of Medicaid drug claims. The specific aims of the project are to: 1) quantify the extent to which pharmacies substitute among bioequivalent generic products in response to changes in Medicaid reimbursement and the broader consequences for pharmaceutical spending; 2) analyze how reductions in Medicaid reimbursement affect generic drug manufacturers' decisions to engage in other distortionary behavior such as strategically discontinuing targeted drug products and introducing reformulated, unregulated versions in order to raise prices; 3) assess how the distortionary effects of Medicaid reimbursement on market outcomes vary across drugs depending on the size of the market, number of generic competitors, and Medicaid market share. This research is the first to examine how reimbursement policies can distort the underlying competitive structure of the prescription drug market and their consequences for healthcare costs. Understanding the impact of reimbursement on provider behavior is highly relevant to policymakers seeking to reduce healthcare costs through alternative reimbursement policies while minimizing the distortions to the pharmaceutical market and prescription drug access for public insurance beneficiaries.

描述（由申请人提供）：越来越多的公共和私营保险公司作为药品购买者可能会对仿制药价格和药品支出产生扭曲影响。保险公司的报销规则改变了药店购买仿制药的激励机制。特别是，报销规则为药店购买价格更高的仿制药提供了激励，诱导仿制药制造商通过设定比竞争对手更高的价格来争夺药品市场份额。虽然这对药品支出有重要影响，但没有研究系统地或定量地分析这些影响。拟议的研究将调查医疗补助药物报销政策对仿制药价格、支出和药房采购的扭曲效应。更具体地说，该项目将研究药房和制造商对一项独特的政策干预的反应，该政策干预导致一组定义明确的仿制药价格急剧下降。在该政策出台之前，许多仿制药的医疗补助报销率和实际药房购买价格之间存在很大差异。这个“自然实验”提供了一个机会来研究医疗补助报销政策在多大程度上扭曲了供应商和制造商的行为。该项目将使用CMS 1994-2004年的医疗补助州药物使用数据，该数据跟踪医疗补助药物索赔范围内国家药物代码（NDC）层面的药物使用情况。