Justine Mallatt (
Abe Dunn, Bureau of Economic Analysis.
Health Aff (Millwood). 2024 Sep;43(9):1284-1289. doi: 10.1377/hlthaff.2023.01344.
The rising price of branded drugs has garnered considerable attention from the public and policy makers. This article investigates the complexities of pharmaceutical pricing, with an emphasis on the overlooked aspects of manufacturer rebates and out-of-pocket prices. Rebates granted by pharmaceutical manufacturers to insurers reduce the actual prices paid by insurers, causing the true prices of prescriptions to diverge from official statistics. We combined claims data on branded retail prescription drugs with estimates on rebates to provide new price index measures based on pharmacy prices, negotiated prices (after rebates), and out-of-pocket prices for the commercially insured population during the period 2007-20. We found that although retail pharmacy prices increased 9.1 percent annually, negotiated prices grew by a mere 4.3 percent, highlighting the importance of rebates in price measurement. Surprisingly, consumer out-of-pocket prices diverged from negotiated prices after 2016, growing 5.8 percent annually while negotiated prices remained flat. The concern over drug price inflation is more reflective of the rapid increase in consumer out-of-pocket expenses than the stagnated inflation of negotiated prices paid by insurers after 2016.
品牌药价格上涨引起了公众和政策制定者的广泛关注。本文研究了药品定价的复杂性，重点关注了制造商回扣和自付费用被忽视的方面。制药商给予保险公司的回扣降低了保险公司实际支付的价格，导致处方药的实际价格与官方统计数据出现偏差。我们将品牌零售处方药的索赔数据与回扣估计相结合，为商业保险人群在 2007-20 年期间提供了基于药房价格、谈判价格（扣除回扣后）和自付费用的新价格指数衡量标准。我们发现，尽管零售药房价格每年上涨 9.1%，但谈判价格仅增长了 4.3%，这突出了回扣在价格衡量中的重要性。令人惊讶的是，消费者自付费用与谈判价格在 2016 年后出现分歧，每年增长 5.8%，而谈判价格保持不变。对药品价格通胀的担忧更多地反映了消费者自付费用的快速增长，而不是 2016 年后保险公司谈判价格的停滞通胀。
