Common Agent or Double Agent? Pharmacy Benefit Managers in the Prescription Drug Market
研究了美国药品福利管理公司作为市场中介，通过品牌药厂竞标返利来优化处方集，并分析了效率、返利、标价和市场力量的决定因素，揭示了常见合同实践和法规如何影响市场效率。
Abstract Pharmacy benefit managers dominate the U.S. pharmaceutical market but are controversial and poorly understood. We analyze PBMs as market intermediaries that operate formulary contests in which on-patent brand-drug makers compete for favorable placement by offering rebates off list price. These formulary contests deliver efficiency gains compared to drug makers selling directly to consumers; PBMs capture some of these gains. Our approach answers key questions regarding the determinants of efficiency, rebates, list prices, and PBM market power in the pharmaceutical market. Our analysis also explains how common contracting practices, federal regulations, and incentives within formulary contests can undermine market efficiency.