The Distortionary Effects of Government Procurement: Evidence from Medicaid Prescription Drug Purchasing

In 2003 the federal-state Medicaid program provided prescription drug coverage to more than 50 million people. To determine the price that it will pay for each drug, Medicaid uses the average private sector price. When Medicaid is a large part of the demand for a drug, this creates an incentive for its maker to increase prices for other health care consumers. Using drug utilization and expenditure data for the top 200 drugs in 1997 and in 2002, we investigate the relationship between the Medicaid market share (MMS) and the average price of a prescription. Our estimates imply that a 10-percentage-point increase in the MMS is associated with a 7 to 10 percent increase in the average price of a prescription. In addition, the Medicaid rules increase a firm's incentive to introduce new versions of a drug in order to raise price. We find empirical evidence that firms producing newer drugs with larger sales to Medicaid are more likely to introduce new versions. Taken together, our findings suggest that government procurement rules can alter equilibrium price and product proliferation in the private sector.

[1]  M. Duggan Do new prescription drugs pay for themselves? The case of second-generation antipsychotics. , 2005, Journal of health economics.

[2]  Amy N. Finkelstein Static and Dynamic Effects of Health Policy: Evidence from the Vaccine Industry , 2004 .

[3]  Dawn M Gencarelli Average wholesale price for prescription drugs: is there a more appropriate pricing mechanism? , 2002, NHPF issue brief.

[4]  J. Currie,et al.  Medicaid Expansions and Welfare Contractions: Offsetting Effects on Prenatal Care and Infant Health? , 2000, Journal of health economics.

[5]  J. Gruber,et al.  Public Health Insurance and Private Savings , 1999 .

[6]  D Parker,et al.  THE PERFORMANCE OF BAA BEFORE AND AFTER PRIVATISATION. A DEA STUDY , 1999 .

[7]  D Parker,et al.  THE PERFORMANCE OF BAA BEFORE AND AFTER PRIVATIZATION , 1999 .

[8]  J. Gruber,et al.  Public Health Insurance and Private Savings , 1997, Journal of Political Economy.

[9]  J. Borrell Pharmaceutical price regulation. A study on the impact of the rate-of-return regulation in the UK. , 1999, PharmacoEconomics.

[10]  Aaron Yelowitz Why Did the Ssi-Disabled Program Grow so Much? Disentangling the Effect of Medicaid , 1997, Journal of health economics.

[11]  M. Olson Substitution in Regulatory Agencies: Fda Enforcement Alternatives , 1996 .

[12]  Fiona M. Scott Morton The Strategic Response by Pharmaceutical Firms to the Medicaid Most-Favored-Customer Rules , 1997 .

[13]  Aaron Yelowitz,et al.  Institute for Research on Poverty Discussion Paper no. 1084-96 The Medicaid Notch, Labor Supply, and Welfare Participation: Evidence from Eligibility Expansions , 1996 .

[14]  D. Salkever,et al.  "Generic Entry and the Pricing of Pharmaceuticals" , 1995 .

[15]  J. Gruber,et al.  Does Public Insurance Crowd Out Private Insurance? , 1995 .

[16]  J. Laffont,et al.  A Theory of Incentives in Procurement and Regulation , 1993 .

[17]  David S. Salkever,et al.  Pricing, Patent Loss and the Market for Pharmaceuticals , 1991 .

[18]  Paul R. Milgrom,et al.  Multitask Principal–Agent Analyses: Incentive Contracts, Asset Ownership, and Job Design , 1991 .

[19]  George Hendrikse,et al.  The Theory of Industrial Organization , 1989 .

[20]  Jerome L. Stein,et al.  Behavior of the Firm Under Regulatory Constraint , 1972 .