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人保险公司作为药品购买者，可能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，报销规则鼓励药店购买价格更高的仿制药，诱使仿制药制造商通过制定高于竞争对手的价格来争夺药店市场份额。虽然这对药品支出有重要影响，但没有系统或定量分析这些影响的研究。 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，这种政策干预导致一组定义明确的仿制药价格急剧下降。在该政策之前，许多这些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。这种“自然实验”提供了一个机会，研究医疗补助报销政策扭曲供应商和制造商的行为的程度。该项目将使用CMS 1994-2004年的医疗补助国家药物利用数据，该数据跟踪医疗补助药物索赔范围内国家药物代码（NDC）水平的药物利用情况。 该项目的具体目标是：1）量化药房在生物等效仿制药中的替代程度，以应对医疗补助报销的变化和对药品支出的更广泛影响; 2）分析医疗补助报销的减少如何影响仿制药制造商参与其他扭曲行为的决定，如战略性地停止目标药物产品和引入新配方，不受管制的版本，以提高价格; 3）评估医疗补助报销对市场结果的扭曲影响如何根据市场规模，仿制药竞争对手的数量和医疗补助市场份额而在药物之间变化。 这项研究是第一个研究报销政策如何扭曲处方药市场的基本竞争结构及其对医疗费用的影响。了解报销对提供者行为的影响与政策制定者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处方药获取的扭曲高度相关。

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.