Department of Economics, Yale University, United States of America.
J Health Econ. 2024 Jan;93:102830. doi: 10.1016/j.jhealeco.2023.102830. Epub 2023 Nov 7.
Prescription drug insurance increasingly imposes prior authorization (requiring providers to request coverage before claim approval) to manage utilization. Prior authorization has been criticized because of its administrative burden on providers. The primary alternative to managing utilization is imposing out-of-pocket (OOP) payment to incentivize beneficiaries to seek lower-cost care, effectively providing beneficiaries with partial insurance. Would beneficiaries prefer indirectly paying for prior authorization through higher premiums; or would they prefer prior authorization was replaced by higher OOP costs? This tradeoff depends on how much OOP costs could be displaced by prior authorization, which depends on their relative impact on demand. I estimate the effect of prior authorization and OOP costs on pharmaceutical demand in Medicare Part D, addressing endogeneity caused by unobserved drug quality and selection into plans. Despite criticism of prior authorization, I find that Medicare beneficiaries would prefer higher premiums to pay for prior authorization, over higher OOP costs.
处方药保险越来越多地要求事先授权（要求提供者在索赔批准前请求保险范围）来管理使用情况。事先授权因其对提供者的行政负担而受到批评。管理利用的主要替代方法是征收自付额（OOP）支付，以激励受益人寻求低成本的医疗服务，实际上为受益人提供部分保险。受益人更愿意通过更高的保费间接支付事先授权费用吗？或者他们更愿意用更高的自付费用来替代事先授权？这种权衡取决于事先授权可以取代多少自付费用，而这取决于它们对需求的相对影响。我在医疗保险部分 D 中估计了事先授权和 OOP 成本对药品需求的影响，解决了由于未观察到的药物质量和计划选择而导致的内生性问题。尽管对事先授权提出了批评，但我发现医疗保险受益人更愿意支付更高的保费来支付事先授权，而不是更高的自付费用。
