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Going through the roof: On prices for drugs sold through insurance

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  • Kamphorst, Jurjen
  • Karamychev, Vladimir A.

Abstract

This paper studies public concern grounds for high prices of drugs treating rare and debilitating diseases. We offer a theory that explains how drug indivisibility, individual budget constraints, and insurance interact to drive up drug prices, especially for drugs treating rare and severe diseases. For a broad range of drug production costs and income distributions, our model predicts that drug prices are either set at their highest levels covered by insurance or inversely related to the prevalence of the disease. In the latter case, producer profits decrease with prevalence. The effect of production costs on prices and profits is non-monotonic.

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  • Kamphorst, Jurjen & Karamychev, Vladimir A., 2025. "Going through the roof: On prices for drugs sold through insurance," Games and Economic Behavior, Elsevier, vol. 151(C), pages 218-242.
    • Handle: RePEc:eee:gamebe:v:151:y:2025:i:c:p:218-242
    DOI: 10.1016/j.geb.2025.03.006
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    1. Darius Lakdawalla & Wesley Yin, 2015. "Insurers’ Negotiating Leverage and the External Effects of Medicare Part D," The Review of Economics and Statistics, MIT Press, vol. 97(2), pages 314-331, May.
    2. Fiona M. Scott Morton, 1997. "The Strategic Response by Pharmaceutical Firms to the Medicaid Most-Favored-Customer Rules," Yale School of Management Working Papers ysm58, Yale School of Management.
    3. Mark Duggan & Fiona Scott Morton, 2010. "The Effect of Medicare Part D on Pharmaceutical Prices and Utilization," American Economic Review, American Economic Association, vol. 100(1), pages 590-607, March.
    4. Vasquez, Markus, 2017. "Utility of wealth with many indivisibilities," Journal of Mathematical Economics, Elsevier, vol. 71(C), pages 20-27.
    5. Ken Binmore & Ariel Rubinstein & Asher Wolinsky, 1986. "The Nash Bargaining Solution in Economic Modelling," RAND Journal of Economics, The RAND Corporation, vol. 17(2), pages 176-188, Summer.
    6. David Besanko & David Dranove & Craig Garthwaite, 2016. "Insurance and the High Prices of Pharmaceuticals," NBER Working Papers 22353, National Bureau of Economic Research, Inc.
    7. G. M.P. Swann, 2009. "The Economics of Innovation," Books, Edward Elgar Publishing, number 13211.
    8. de Meza, David, 1983. "Health insurance and the demand for medical care," Journal of Health Economics, Elsevier, vol. 2(1), pages 47-54, March.
    9. Boone, Jan, 2020. "Pricing above Value: Selling to an Adverse Selection Market," Discussion Paper 2020-023, Tilburg University, Center for Economic Research.
    10. Brekke, Kurt R. & Holmas, Tor Helge & Straume, Odd Rune, 2011. "Reference pricing, competition, and pharmaceutical expenditures: Theory and evidence from a natural experiment," Journal of Public Economics, Elsevier, vol. 95(7), pages 624-638.
    11. Salop, Steven C, 1979. "Strategic Entry Deterrence," American Economic Review, American Economic Association, vol. 69(2), pages 335-338, May.
    12. Boone, Jan, 2020. "Pricing above Value: Selling to an Adverse Selection Market," Other publications TiSEM 700b2f3e-d1c8-4422-9b54-f, Tilburg University, School of Economics and Management.
    13. Daron Acemoglu & Joshua Linn, 2004. "Market Size in Innovation: Theory and Evidence from the Pharmaceutical Industry," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 119(3), pages 1049-1090.
    14. Mark Duggan & Fiona M. Scott Morton, 2006. "The Distortionary Effects of Government Procurement: Evidence from Medicaid Prescription Drug Purchasing," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 121(1), pages 1-30.
    15. Cheng Yuan & Yu Jiang, 2015. "Factors affecting the demand for insurance in China," Applied Economics, Taylor & Francis Journals, vol. 47(45), pages 4855-4867, September.
    16. Boone, Jan, 2020. "Pricing above Value: Selling to an Adverse Selection Market," Other publications TiSEM eda6a1de-4db6-49a6-87e4-3, Tilburg University, School of Economics and Management.
    17. Fiona Scott Morton, 1997. "The Strategic Response by Pharmaceutical Firms to the Medicaid Most-Favored-Customer Rules," RAND Journal of Economics, The RAND Corporation, vol. 28(2), pages 269-290, Summer.
    18. Michael Rothschild & Joseph Stiglitz, 1976. "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 90(4), pages 629-649.
    19. Dyfrig A Hughes & Jannine Poletti-Hughes, 2016. "Profitability and Market Value of Orphan Drug Companies: A Retrospective, Propensity-Matched Case-Control Study," PLOS ONE, Public Library of Science, vol. 11(10), pages 1-12, October.
    20. Martin Gaynor & Deborah Haas-Wilson & William B. Vogt, 2000. "Are Invisible Hands Good Hands? Moral Hazard, Competition, and the Second-Best in Health Care Markets," Journal of Political Economy, University of Chicago Press, vol. 108(5), pages 992-1005, October.
    21. Markus Fels, 2020. "On the value of Medicaid in providing access to long‐term care," Journal of Public Economic Theory, Association for Public Economic Theory, vol. 22(4), pages 933-948, August.
    22. Darius N. Lakdawalla, 2018. "Economics of the Pharmaceutical Industry," Journal of Economic Literature, American Economic Association, vol. 56(2), pages 397-449, June.
    23. Lakdawalla, Darius N. & Phelps, Charles E., 2020. "Health technology assessment with risk aversion in health," Journal of Health Economics, Elsevier, vol. 72(C).
    24. Besanko, David & Dranove, David & Garthwaite, Craig, 2020. "Insurance access and demand response: Pricing and welfare implications," Journal of Health Economics, Elsevier, vol. 73(C).
    25. Lakdawalla, Darius & Sood, Neeraj, 2009. "Innovation and the welfare effects of public drug insurance," Journal of Public Economics, Elsevier, vol. 93(3-4), pages 541-548, April.
    26. Boone, Jan, 2020. "Pricing above value: selling to an adverse selection market," CEPR Discussion Papers 15279, C.E.P.R. Discussion Papers.
    27. Nyman, John A., 1999. "The value of health insurance: the access motive," Journal of Health Economics, Elsevier, vol. 18(2), pages 141-152, April.
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    Cited by:

    1. Boone, Jan, 2024. "Pricing above value: Selling to a market with selection problems," Journal of Health Economics, Elsevier, vol. 94(C).

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    Keywords

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    JEL classification:

    • D42 - Microeconomics - - Market Structure, Pricing, and Design - - - Monopoly
    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • L12 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Monopoly; Monopolization Strategies

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