The economics of alternative payment models for pharmaceuticals.
The economics of alternative payment models for pharmaceuticals.
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DOI：
10.1007/s10198-021-01274-4
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Lakdawalla DN
中科院分区：
文献类型：
--
作者：
Hlávka JP;Yu JC;Goldman DP;Lakdawalla DN
药品按惯例统一定价，但对不同疾病适应症的有效程度不同。随着越来越多的高成本疗法的推出，许多发达市场对替代支付模式（APM）的需求一直在增加，尽管这些模式存在有据可查的局限性和实施挑战。这种合同的政策理由之一是在资源稀缺的情况下实现价值最大化。我们发现，虽然统一的定价规则可以处理有效市场中的可变有效性，但其他类型的市场无效率会为不同的基于价值的定价结构发挥作用。我们首先提出了一个程式化的理论模型，有效的药物制造商，付款人和受益人之间的互动。在这种程式化的环境中，即使治疗效果是可变的，统一定价也能很好地发挥作用。然后，我们使用这个框架来定义市场失灵，导致统一定价的障碍。我们识别的市场失灵包括：（1）患者分布的不确定性，（2）不对称的信念，（3）支付者的代理不完善，（4）提供者的代理不完善，（5）患者行为和治疗依从性。然后，我们将我们的见解应用于替代支付模式的现实例子，并强调与合同实施相关的挑战。
Pharmaceuticals are priced uniformly by convention, but vary in their degree of effectiveness for different disease indications. As more high-cost therapies have launched, the demand for alternative payment models (APMs) has been increasing in many advanced markets, despite their well-documented limitations and challenges to implementation. Among policy justifications for such contracts is the maximization of value given scarce resources. We show that while uniform pricing rules can handle variable effectiveness in efficient markets, market inefficiencies of other kinds create a role for different value-based pricing structures. We first present a stylized theoretical model of efficient interaction among drug manufacturers, payers, and beneficiaries. In this stylized setting, uniform pricing works well, even when treatment effects are variable. We then use this framework to define market failures that result in obstacles to uniform pricing. The market failures we identify include: (1) uncertainty of patient distribution, (2) asymmetric beliefs, (3) agency imperfection by payer, (4) agency imperfection by provider, and (5) patient behavior and treatment adherence. We then apply our insights to real-world examples of alternative payment models, and highlight challenges related to contract implementation.
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DOI：
10.1331/japha.2013.12202
发表时间：
2013-03
期刊：
Journal of the American Pharmacists Association : JAPhA
影响因子：
--
作者：
Dayer L;Heldenbrand S;Anderson P;Gubbins PO;Martin BC
通讯作者：
Martin BC
影响因子：
10.7
作者：
Goldman, Dana;Philipson, Tomas J.
通讯作者：
Philipson, Tomas J.
影响因子：
9.7
作者：
Hussey, Peter S.;Ridgely, M. Susan;Rosenthal, Meredith B.
通讯作者：
Rosenthal, Meredith B.
影响因子：
3.5
作者：
Chen, Alice;Lakdawalla, Darius N.
通讯作者：
Lakdawalla, Darius N.
影响因子：
9.7
作者：
Goldman, Dana P.;Jena, Anupam B.;Sun, Eric
通讯作者：
Sun, Eric