The Impact of Medicaid Reimbursement Policies on Pharmaceutical Spending

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的购买者，可能会对仿制药价格和药品支出产生扭曲的影响。保险公司的报销规则改变了药店购买仿制药的激励措施。特别是，报销规则为药店提供了购买价格更高的仿制药的激励措施，促使仿制药制造商通过设定比竞争对手更高的价格来争夺药房的市场份额。虽然这对药品支出有重要影响，但还没有系统或定量分析这些影响的研究。这项拟议的研究将调查医疗补助药品报销政策对仿制药价格、支出和药房购买的扭曲影响。更具体地说，该项目将研究药房和制造商对一种独特的政策干预的反应，这一干预导致一套定义明确的仿制药的价格大幅下降。在这项政策之前，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着很大的差异。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利用数据，该数据跟踪国家药品代码(NDC)级别的药物利用情况，用于医疗补助药物声明的范围。 该项目的具体目标是：1)根据医疗补助报销的变化和药品支出的更广泛后果，量化药房在生物等效仿制药中进行替代的程度；2)分析医疗补助报销的减少如何影响仿制药制造商从事其他扭曲行为的决定，例如战略性地停止生产靶向药物和推出重新配制的、不受监管的版本以提高价格；3)评估医疗补助报销对市场结果的扭曲效应如何在不同的药物上根据市场规模、仿制药竞争者的数量和医疗补助的市场份额而变化。这项研究首次考察了报销政策如何扭曲处方药市场的潜在竞争结构及其对医疗成本的影响。了解报销对提供者行为的影响，对于寻求通过替代报销政策降低医疗成本，同时最大限度地减少对药品市场和公共保险受益人的处方药获取的扭曲的政策制定者来说，具有高度的相关性。

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.