利用“最惠客户”采购规则获利：来自医疗补助计划的证据

中文摘要

采用双重差分方法，我们发现，2010年《平价医疗法案》提高医疗补助计划的最低药品回扣后，非医疗补助药品支出降低了2.5%。一个程式化议价模型表明，这很可能是由该改革与医疗补助计划的“最惠客户”条款（MFCC）之间的相互作用所驱动的。通过考察那些所面临的激励变化等同于取消医疗补助计划MFCC的药品的反应，我们估计，取消医疗补助计划MFCC本可使2010年非医疗补助药品总体支出进一步降低3.5%，但也很可能会增加医疗补助计划的支出。

Abstract

Using a difference-in-difference approach, we find that an increase to Medicaid’s minimum drug rebate under the Affordable Care Act in 2010 lowered non-Medicaid drug spending by 2.5 percent. A stylized bargaining model shows that this is likely driven by the interaction of this reform with Medicaid’s “most-favored customer” clause (MFCC). By examining the response of drugs that faced a change in incentives equivalent to the removal of Medicaid’s MFCC, we estimate that removing the Medicaid MFCC would have reduced overall 2010 non-Medicaid drug spending by an additional 3.5 percent, though it would have likely also increased Medicaid spending. (JEL C78, H51, I18, I38, L65)