使竞争对手处于不利地位：医药市场中的纵向一体化

中文摘要

近年来，医药市场经历了一轮药品福利管理机构（PBM）与保险公司之间的纵向一体化浪潮。利用一套独特的保险公司—PBM合同数据集，我们记录了美国联邦医疗保险（Medicare）D部分中日益增强的纵向一体化趋势。接下来，我们评估了2015年一起大型保险公司—PBM合并案的影响，考察纵向一体化的权衡：一方面损害竞争，另一方面提高效率。我们发现，合并后竞争对手保险公司的保费上升，这与纵向一体化的PBM通过投入品封锁提高其成本的机制相一致。我们未发现合并企业的消费者因保费降低而受益的证据。（JEL G22、G34、I13、I18、L22、L65）

Abstract

The pharmaceutical market has experienced a wave of vertical integration between pharmacy benefit managers (PBMs) and insurers in recent years. Using a unique dataset on insurer-PBM contracts, we document increasing vertical integration in Medicare Part D. Next, we evaluate the effects of a large insurer-PBM merger in 2015, assessing the trade-offs of vertical integration—harms to competition on the one hand and improved efficiency on the other. We find premium increases for rival insurers post-merger, consistent with vertically integrated PBMs raising costs through input foreclosure. We find no evidence of benefits to consumers of the merged firm from lower premiums. (JEL G22, G34, I13, I18, L22, L65)