处方药广告与药品利用：Medicare Part D 的作用

中文摘要

本文利用 Medicare Part D 的实施所带来的对直接面向消费者广告（DTCA）的一次大规模且外生性可信的冲击，考察处方药的直接面向消费者广告如何影响药品利用。Part D 使 Medicare 受益人密度更高的地理区域的广告增幅更大。我们考察广告的这一差异性增长对非老年人群的影响，以将广告效应与 Part D 的直接效应相剥离。我们发现，接触广告导致治疗起始大幅增加，并改善了用药依从性。广告还对未被广告的仿制药产生了可观的正面溢出效应。我们的结果表明，Medicare Part D 对 65 岁以下人群存在显著溢出效应，且非价格因素在影响处方药利用方面发挥着重要作用。

Abstract

This paper examines how direct-to-consumer advertising (DTCA) for prescription drugs influences utilization by exploiting a large and plausibly exogenous shock to DTCA driven by the introduction of Medicare Part D. Part D led to larger increases in advertising in geographic areas with higher concentrations of Medicare beneficiaries. We examine the impact of this differential increase in advertising on non-elderly individuals to isolate advertising effects from the direct effects of Part D. We find that exposure to advertising led to large increases in treatment initiation and improved medication adherence. Advertising also had sizeable positive spillover effects on non-advertised generic drugs. Our results imply significant spillovers from Medicare Part D on the under-65 population and an important role for non-price factors in influencing prescription drug utilization.