共同代理人还是双重代理人？处方药市场中的药品福利管理公司
Common Agent or Double Agent? Pharmacy Benefit Managers in the Prescription Drug Market
Review of Economics and Statistics · 2026 · [{"name": "Rena M. Conti", "affiliation": ["University of Chicago"]}, {"name": "Brigham Frandsen", "affiliation": ["Brigham Young University"]}, {"name": "Michael F. Powell", "affiliation": ["Kellogg's (Canada)"]}, {"name": "James B. Rebitzer", "affiliation": ["Boston University"]}]
中文摘要
摘要：药品福利管理机构（PBM）主导着美国药品市场，但其颇具争议且未得到充分理解。我们将 PBM 视为运作处方集竞争的市场中介：在这类竞争中，专利期内的品牌药制造商通过提供相对于标价的返利来争取有利的处方集位置。与药品制造商直接向消费者销售相比，这些处方集竞争带来了效率收益；PBM 获取了其中一部分收益。我们的方法回答了有关药品市场中效率、返利、标价以及 PBM 市场势力决定因素的关键问题。我们的分析还解释了常见的合同做法、联邦法规以及处方集竞争中的激励机制如何可能损害市场效率。
Abstract
Abstract Pharmacy benefit managers dominate the U.S. pharmaceutical market but are controversial and poorly understood. We analyze PBMs as market intermediaries that operate formulary contests in which on-patent brand-drug makers compete for favorable placement by offering rebates off list price. These formulary contests deliver efficiency gains compared to drug makers selling directly to consumers; PBMs capture some of these gains. Our approach answers key questions regarding the determinants of efficiency, rebates, list prices, and PBM market power in the pharmaceutical market. Our analysis also explains how common contracting practices, federal regulations, and incentives within formulary contests can undermine market efficiency.