费希尔-舒尔茨讲座：关于药品处方集与回扣的合同
Fisher–Schultz Lecture: Contracting Over Pharmaceutical Formularies and Rebates
Econometrica · 2026 · [{"name": "Kate Ho", "affiliation": ["Princeton University"]}, {"name": "Robin S. Lee", "affiliation": ["Harvard University"]}]
中文摘要
本文考察药品福利管理机构(PBM)所使用的处方集如何通过分层与排除影响品牌药制造商回扣的均衡水平。我们构建了一个多维契约理论模型: PBM 与药品制造商就以处方集为条件的回扣菜单进行谈判, 并选择处方集。随后, 我们利用普林斯顿大学的理赔数据——该大学作为一家大型雇主, 与单一 PBM 签约为其雇员提供处方药保险——估计消费者需求对他汀类药物分层位置的响应。将理论模型与需求估计及观测到的标价相结合, 我们量化了允许差异化分层位置与排除对均衡回扣的影响。我们的预测与可得的汇总回扣数据一致, 并发现允许 PBM 将品牌药置于优先层级与非优先层级, 可显著提高谈判达成的回扣支付。
Abstract
We investigate how formularies used by pharmacy benefit managers (PBMs) affect equilibrium manufacturer rebates for branded drugs through tiering and exclusion. We develop a theoretical model of multidimensional contracting in which a PBM negotiates with drug manufacturers over menus of formulary‐contingent rebates and chooses a formulary. We then estimate consumer demand responses to tier placement for statins using claims data from Princeton University, a large employer contracting with a single PBM to offer prescription drug coverage to its employees. Combining the theoretical model with demand estimates and observed list prices, we quantify how allowing for differential tier placement and exclusion affect equilibrium rebates. Our predictions are consistent with available aggregate rebate data, and we find that allowing a PBM to place branded drugs on preferred‐ and non‐preferred tiers can substantially increase negotiated rebate payments.