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Eliminating drug price differentials across government programmes in the USA

Published online by Cambridge University Press:  04 February 2010

Kalipso Chalkidou ,
Gerard F Anderson  and
Ruth Faden
Kalipso Chalkidou*
Affiliation:
Director, NICE International, National Institute for Health and Clinical Excellence, London, UK and Visiting Faculty, Johns Hopkins Berman Institute of Bioethics, Baltimore, USA
Gerard F Anderson
Affiliation:
Professor of Health Policy, and Director, Center for Hospital Finance and Management, Johns Hopkins Bloomberg School of Public Health, USA
Ruth Faden
Affiliation:
Wagley Professor of Biomedical Ethics and Director, Johns Hopkins Berman Institute of Bioethics, USA
*
Correspondence to: Dr Kalipso Chalkidou, Director, NICE International, National Institute for Health and Clinical Excellence, 71 High Holborn, London WC1 V 6NA, UK. Email: kalipso.chalkidou@nice.org.uk
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Abstract

Federal agencies in the USA pay significantly different prices for the same prescription drugs because each agency uses a different approach to derive the payment rate. Because we do not identify any economic rationale or socially accepted moral reasoning that would justify the current level of price variation, we suggest that the federal government should pay a uniform price for each drug. Laws and regulations that give certain federal agencies the ability to earn rebates, use formularies, or permit other special arrangements would need to be eliminated in order to have a single payment rate. This could make some government agencies worse off than others; however, a uniform payment rate would not need to affect beneficiaries’ current financial contributions, access to drugs, benefits or overall public expenditures. At the same time, having a single rate would permit the government to adopt a more effective approach to purchasing drugs and send a consistent message to pharmaceutical companies concerning which types of drugs the government wants them to develop for government beneficiaries. How this single price would be derived and how it would compare with the lowest or highest prices currently achieved by government agencies would depend on a variety of policy issues including the government’s desire to encourage pharmaceutical research and development and the need to control health care spending.

Type
Articles
Information
Health Economics, Policy and Law , Volume 6 , Issue 1 , 26 January 2011 , pp. 43 - 64
Copyright
Copyright © Cambridge University Press 2010

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References

Anderson, G. F., Shea, D. G., Hussey, P. S., Keyhani, S.Zephyrin, L. (2004), ‘Doughnut holes and price controls’, Health Affairs (Millwood) Suppl Web Exclusives: W4-396-404.Google ScholarPubMed
Armstrong, M. (2006), ‘Recent developments in the economics of price discrimination’, in R. Blundell, W. K. Newey and T. Persson (eds), Advances in Economics and Econometrics: Theory and Applications: Ninth World Congress, volume II, Cambridge, UK: Cambridge University Press: 97–141.CrossRefGoogle Scholar
Atkinson, A. B. (1983), The Economics of Inequality, Oxford: Clarendon Press.Google Scholar
Beauchamp, T. L.Childress, J. F. (1994), Principles of Biomedical Ethics, 4th edition. New York: Oxford University Press.Google Scholar
Berenson, A. (2006), ‘As drug prices climb, democrats find fault with medicare plan’, The New York Times.Google Scholar
Brock, D. W. (2002), ‘Priority to the worse off in health-care resource prioritization’, in R. Rhodes, M. Battin and A. Silvers (eds), Medicine and Social Justice, Oxford: Oxford University Press: 362–372.CrossRefGoogle Scholar
Center for Medicare Advocacy (2008). Summary of Medicare Prescription Drug Plans.Google Scholar
Chalkidou, K., Tunis, S., Lopert, R., Rochaix, L., Sawicki, P. T., Nasser, M.Xerri, B. (2009), ‘Comparative effectiveness research and evidence-based health policy: experience from four countries’, The Milbank Quarterly, 87(2): 339–367.CrossRefGoogle ScholarPubMed
Cohen, F. J. (2005), ‘Macro trends in pharmaceutical innovation’, Nature Reviews. Drug Discovery, 4(1): 78–84.CrossRefGoogle ScholarPubMed
Congressional Budget Office (1996), How the Medicaid Rebate on Prescriptions Drugs Affects Pricing in the Pharmaceutical Industry. Washington, DC.Google Scholar
Congressional Budget Office (2005), Prices for Brand-Name Drugs Under Selected Federal Programs, Washington, DC.Google Scholar
Corts, K. S. (1998), ‘Third degree price discrimination in oligopoly: all-out competition and strategic commitment’, The RAND Journal of Economics, 29(2): 306–323.CrossRefGoogle Scholar
Daniels, N. (2008), Just Health: Meeting Health Needs Fairly, Cambridge: Cambridge University Press: 11–28.Google Scholar
Danzon, P. M. (1997), ‘Price discrimination for pharmaceuticals: welfare effects in the US and the EU’, International Journal of the Economics of Business, 4(3): 301–321.CrossRefGoogle Scholar
Dasgupta, P.Stiglitz, J. (1980), ‘Uncertainty, industrial structure and the speed of R&D’, The Bell Journal of Economics, 11(1): 1–28.CrossRefGoogle Scholar
Department of Health (2009), The 2009 Pharmaceutical Price Regulation Scheme, London.Google Scholar
Dorsey, E. R., Thompson, J. P., Carrasco, M., de Roulet, J., Vitticore, P., Nicholson, S., Johnston, S. C., Holloway, R. G.Moses, H. 3rd (2009), ‘Financing of US biomedical research and new drug approvals across therapeutic areas’, PLoS One, 4(9): e7015.CrossRefGoogle ScholarPubMed
Duggan, M., Scott-Morton, F. (2005), The distortionary effects of government procurement: evidence from medicaid prescription drug purchasing. In Working paper.CrossRefGoogle Scholar
Frank, R. G. (2001), ‘Prescription drug prices: why do some pay more than others do?’, Health Affairs (Millwood), 20(2): 115–128.CrossRefGoogle Scholar
Frank, R. G.Newhouse, J. P. (2008), ‘Should drug prices be negotiated under part D of Medicare? and if so, how?’, Health Affairs (Millwood), 27(1): 33–43.CrossRefGoogle Scholar
Frank, R.Newhouse, J. (2007), ‘Mending the medicare prescription drug benefit: improving consumer choices and restructuring purchasing’, in The Hamilton Project, Washington, DC: The Brookings Institution.Google Scholar
Gagnon, M. A.Lexchin, J. (2008), ‘The cost of pushing pills: a new estimate of pharmaceutical promotion expenditures in the United States’, PLoS Medicine, 5(1): e1.CrossRefGoogle ScholarPubMed
Galbraith, J. K. (1952), American Capitalism, The Concept of Countervailing Power, Boston: Houghton Mifflin.Google Scholar
Garber, A., Jones, C., Romer, P. 2006. Insurance and Incentives for Medical Innovation, NBER Working Paper.CrossRefGoogle Scholar
Garber, A. M. (2004), ‘Cost-effectiveness and evidence evaluation as criteria for coverage policy’, Health Affairs (Millwood), Suppl Web Exclusives: W4-284-96.Google ScholarPubMed
Garber, A. M.McClellan, M. B. (2007), ‘Satisfaction guaranteed – “payment by results” for biologic agents’, The New England Journal of Medicine, 357(16): 1575–1577.CrossRefGoogle ScholarPubMed
Ginsburg, P. B. (2003), ‘Can hospitals and physicians shift the effects of cuts in Medicare reimbursement to private payers?’, Health Affairs (Millwood), Suppl Web Exclusives: W3-472-9.Google ScholarPubMed
Gold, M. (1996), Cost-effectiveness in Health and Medicine, Washington, DC: Oxford University Press.CrossRefGoogle ScholarPubMed
Gold, M. R., Sofaer, S.Siegelberg, T. (2007), ‘Medicare and cost-effectiveness analysis: time to ask the taxpayers’, Health Affairs (Millwood), 26(5): 1399–1406.CrossRefGoogle ScholarPubMed
Government Accountability Office (1991), Medicaid: Changes in Drug Prices Paid by VA and DoD Since Enactment of Rebate Provisions, Washington, DC.Google Scholar
Government Accountability Office (1993), Changes in Drug Prices Paid by HMOs and Hospitals Since Enactment of Rebate Provisions, Washington, DC.Google Scholar
Government Accountability Office (2007), E Dicken Testimony Before the Committee on Finance, An Overview of Approaches to Negotiate Drug Prices used by Other Countries and US Private Payers and Federal Programs, Washington, DC: Committee on Finance.Google Scholar
Hausman, J.MacKie-Mason, J. (1988), ‘Price discrimination and patent policy’, The RAND Journal of Economics, 19(2): 253–265.CrossRefGoogle Scholar
Hogberg, D. (2007), ‘Letting Medicare “Negotiate” Drug Prices: Myths vs. Reality, National Center for Public Policy research 2007’, http://www.nationalcenter.org/NPA550MedicareDrugPrices.html [cited April 2008].Google Scholar
Holmes, T. (1989), ‘The effects of third degree price discrimination in oligopoly’, The American Economic Review, 79(1): 244–250.Google Scholar
House Oversight Committee (2007), High Expenses and Low Rebates Increase the Costs of Medicare Drug Coverage, Washington, DC.Google Scholar
Jacobson, G (2007). Pharmaceutical Costs: A Comparison of VA, Medicaid and Medicare Policies, edited by Congressional Research Office, Washington, DC.Google Scholar
Kaiser Family Foundation (2007), Medicare part D 2008 data spotlight: Premiums.Google Scholar
Kyle, M. K.Ridley, D. B. (2007), ‘Would greater transparency and uniformity of health care prices benefit poor patients?’, Health Affairs (Millwood), 26(5): 1384–1391.CrossRefGoogle ScholarPubMed
Light, D. W. (2009), ‘Global drug discovery: Europe is ahead’, Health Affairs (Millwood), 28(5): w969–w977.CrossRefGoogle ScholarPubMed
Lopert, R.Moon, M. (2007), ‘Toward a rational, value-based drug benefit for Medicare’, Health Affairs (Millwood), 26(6): 1666–1673.CrossRefGoogle Scholar
Mooney, G. (1987), ‘What does equity in health mean? Qu’est-ce que l’equite en matiere de sante?’, World Health Statistics Quarterly. Rapport Trimestriel De Statistiques Sanitaires Mondiales, 40: 296–303.Google Scholar
Morrisey, M. A. (2003), ‘Cost shifting: new myths, old confusion, and enduring reality’, Health Affairs (Millwood), Suppl Web Exclusives: W3-489-91.CrossRefGoogle ScholarPubMed
Morrisey, M. A. (1996), Employee Benefit Research Institute issue brief.Google Scholar
New Molecular Entities slump continues: FDA clears 18 novel drugs in 2006, same as 2005. 2007. Pharmaceutical Approvals Monthly 12(1): 7–12.Google Scholar
Newhouse, J. P. (2004), ‘How much should Medicare pay for drugs?’, Health Affairs (Millwood), 23(1): 89–102.CrossRefGoogle ScholarPubMed
Omnibus Budget Reconciliation Act of 1990 OBRA-90, Pub.L. 101-508, 104 Stat. 1388. 1990-11-05.Google Scholar
Pharmaceutical Research and Manufacturers of America (2004). Industry Profile.Google Scholar
Pigou, A. C. (1920), The Economics of Welfare, London: Macmillan.Google Scholar
Poisal, J. A., Truffer, C., Smith, S., Sisko, A., Cowan, C., Keehan, S.Dickensheets, B. (2007), ‘Health spending projections through 2016: modest changes obscure part D’s impact’, Health Affairs (Millwood), 26(2): w242–w253.CrossRefGoogle ScholarPubMed
Pollard, M. R.Coster, J. M. (1991), ‘Savings for Medicaid drug spending’, Health Affairs (Millwood), 10(2): 196–206.CrossRefGoogle ScholarPubMed
Powers, M.Faden, R. (2000), ‘Inequalities in health, inequalities in health care: four generations of discussion about justice and cost-effectiveness analysis’, Kennedy Institute of Ethics Journal, 10(2): 109–127.CrossRefGoogle ScholarPubMed
Ramsey, F. P. (1927), ‘A contribution to the theory of taxation’, The Economic Journal, 37(145): 47–61.CrossRefGoogle Scholar
Reinhardt, U. E. (2001), ‘Perspectives on the pharmaceutical industry’, Health Affairs (Millwood), 20(5): 136–149.CrossRefGoogle ScholarPubMed
Reinhardt, U. E., Hussey, P. S.Anderson, G. F. (2004), ‘US health care spending in an international context’, Health Affairs (Millwood), 23(3): 10–25.CrossRefGoogle Scholar
Robinson, J. (1933), The Economics of Imperfect Competition, London: Macmillan.Google Scholar
Scherer, F. M. (1997), ‘How US antitrust can go astray: the brand name prescription drug litigation’, International Journal of the Economics of Business, 4(3): 239–256.CrossRefGoogle Scholar
Schmalensee, R. (1981), ‘Output and welfare implications of monopolistic third-degree price discrimination’, American Economic Review, 71(1): 242–247.Google Scholar
Scott-Morton, F. (1997), ‘The strategic response by pharmaceutical firms to the Medicaid most-favoured-customer rules’, Rand Journal of Economics, 28(2): 269–290.CrossRefGoogle Scholar
Skinner, J. S., Staiger, D. O.Fisher, E. S. (2006), ‘Is technological change in medicine always worth it? the case of acute myocardial infarction’, Health Affairs (Millwood), 25(2): w34–w47.CrossRefGoogle Scholar
Tandon, P. (1983), ‘Rivalry and the excessive allocation of resources to research’, The Bell Journal of Economics, 14(1): 152–165.CrossRefGoogle Scholar
Tritz, K. (2005), A CRS Series on Medicaid: Dual Eligibles, edited by Congressional Research Service. Washington, DC: The Library of Congress.Google Scholar
Ubel, P. A. (2001), Pricing Life: Why It’s Time for Health Care Rationing, Cambridge, MA: The MIT Press.Google Scholar
United States District Court and District of Massachusetts. Pharmaceutical Industry Average Wholesale Price Litigation. In M.D.L. No. 1456, Civil Action No. 01-12257-PBS.Google Scholar
Veatch, R. M. (1999), Justice, the Basic Social Contract, and Health Care. Contemporary Issues in Bioethics, 5th edition. Belmont, CA: Wadsworth.Google Scholar
Waters, H. R. (2000), ‘Measuring equity in access to health care’, Social Science and Medicine, 51(4): 599–612.CrossRefGoogle ScholarPubMed