对 Kate Ho 和 Robin Lee 费希尔-舒尔茨讲座：关于药品处方集与回扣的合同的评论
Comment on ‘Fisher–Schultz Lecture: Contracting Over Pharmaceutical Formularies and Rebates’ by Kate Ho and Robin Lee
Econometrica · 2026 · [{"name": "Rena M. Conti", "affiliation": ["Boston University", "Quest University Canada"]}]
中文摘要
生物制药推动健康与经济增长。与国外的集中谈判不同, 美国依靠私营企业——药品福利管理机构 (PBM)——来管理药品的可及性与支出。然而, PBM 在提升效率方面的作用尚未得到充分研究。Ho 和 Lee 在未使用药品制造商为换取优先位置而提供的价格让步这一专有数据的情况下, 对 PBM 使用分层处方集 (即承保药品清单) 的行为进行了建模。他们发现, PBM 使用分层处方集可通过竞争为支付方带来显著的节约。作为对 Ho 和 Lee 的补充, Feng 和 Maini (2024) 建模分析了患者需求惯性如何限制 PBM 从药品制造商处获取价格让步的能力, 并因此侵蚀 PBM 处方集所带来的效能收益。Conti、Frandsen、Powell 和 Rebitzer (2021) 对处方集拍卖进行建模, 其中 PBM 规模驱动支付方节约, 但同时也刺激内生设定的高标价, 从而降低患者的可及性。未来的经济学研究应聚焦于 PBM 的市场进入与纵向一体化、药房引导以及对创新的影响。
Abstract
Biopharmaceuticals advance health and economic growth. Unlike central bargaining abroad, the United States uses private firms, pharmacy benefit managers (PBMs), to manage medicine access and spending. Yet, PBMs' roles in advancing efficiency are understudied. Ho and Lee model PBMs' use of tiered formularies, lists of covered medicines, without the use of proprietary data on the price concessions drug makers offer for preferred placement. They find PBMs' use of tiered formularies generate significant payor savings through competition. Complementing Ho and Lee, Feng and Maini (2024) model how patient demand inertia limits PBMs' ability to extract price concessions from drug makers which consequently erodes the efficacy gains of PBM formularies. Conti, Frandsen, Powell, and Rebitzer (2021) model formulary auctions where PBM size drives payor savings, but also spurs endogenously set high list prices, reducing patient access. Future economic research should focus on PBM market entry and vertical integration, pharmacy steering, and effects on innovation.