竞争至关重要:药品的统一定价与基于适应症的定价

Pharmaceutical expenditures are rising rapidly, driven in part by the innovation of highly effective but very expensive drug therapies that treat multiple diseases, implying that payers face a critical trade-off between cost containment and access to new medicines. A key policy question is whether producers should be restricted to uniform pricing or allowed to use indication-based pricing, where prices vary across patient groups. We use a two-market model to analyse how this choice affects drug producers' incentives to invest in new indications, their pricing strategies, and the resulting surplus for health plans. In a monopoly setting, indication-based pricing yields higher profits and thus strengthens incentives to invest in new indications, while the payer prefers uniform pricing unless the fixed investment costs cannot be recouped. However, monopoly-based insights may not hold if the multi-indication producer faces therapeutic competition in one of the markets. Specifically, we identify a softening-of-competition effect, where a uniform pricing restriction serves as a credible commitment to raise prices in the competitive market. In this case, the health plan might favour indication-based pricing to reduce costs. Overall, our findings suggest that neither pricing scheme is universally optimal, underscoring the need for case-by-case assessments across drug classes.