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Insurers’ Negotiating Leverage and the External Effects of Medicare Part D

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Listed:
  • Darius Lakdawalla

    (University of Southern California and NBER)

  • Wesley Yin

    (University of Southern California and NBER)

Abstract

By influencing the size and bargaining power of private insurers, public subsidization of private health insurance may project effects beyond the subsidized population. We test for such spillovers by analyzing how increases in insurer size resulting from the implementation of Medicare Part D affected drug prices negotiated in the non-Medicare commercial market. On average, Part D lowered prices for commercial enrollees by 3.7 percentage. The external commercial market savings amount to $1.5 billion per year, which, if passed to consumers, approximates the internal cost savings of newly insured subsidized beneficiaries. If retained by insurers, it corresponds to a greater than 9.25 percentage average increase in profitability on stand-alone drug insurance. © 2015 The President and Fellows of Harvard College and the Massachusetts Institute of Technology

Suggested Citation

  • 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.
    • Handle: RePEc:tpr:restat:v:97:y:2015:i:2:p:314-331
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    Cited by:

    1. Bognar, Katalin & Romley, John A. & Bae, Jay P. & Murray, James & Chou, Jacquelyn W. & Lakdawalla, Darius N., 2017. "The role of imperfect surrogate endpoint information in drug approval and reimbursement decisions," Journal of Health Economics, Elsevier, vol. 51(C), pages 1-12.
    2. Abe Dunn & Adam Hale Shapiro, 2019. "Does Medicare Part D Save Lives?," American Journal of Health Economics, MIT Press, vol. 5(1), pages 126-164, Winter.
    3. Jeroen Hinloopen & Adriaan R. Soetevent, 2020. "(Non‐)Insurance Markets, Loss Size Manipulation and Competition: Experimental Evidence," Journal of Industrial Economics, Wiley Blackwell, vol. 68(4), pages 819-856, December.
    4. Mark G. Duggan & Fiona Scott Morton, 2011. "The Medium-Term Impact of Medicare Part D on Pharmaceutical Prices," American Economic Review, American Economic Association, vol. 101(3), pages 387-392, May.
    5. Keith M. Marzilli Ericson, 2014. "Consumer Inertia and Firm Pricing in the Medicare Part D Prescription Drug Insurance Exchange," American Economic Journal: Economic Policy, American Economic Association, vol. 6(1), pages 38-64, February.
    6. Daniel P. Miller & Jungwon Yeo, 2019. "The Consequences of a Public Health Insurance Option: Evidence from Medicare Part D," American Journal of Health Economics, MIT Press, vol. 5(2), pages 191-226, Spring.
    7. Brandyn F. Churchill & Laura E. Henkhaus & Emily C. Lawler, 2025. "Effect of vaccine recommendations on consumer and firm behavior," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 44(1), pages 125-150, January.
    8. 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.
    9. Alpert, Abby & Lakdawalla, Darius & Sood, Neeraj, 2023. "Prescription drug advertising and drug utilization: The role of Medicare Part D," Journal of Public Economics, Elsevier, vol. 221(C).
    10. Eric Helland & Darius Lakdawalla & Anup Malani & Seth A Seabury, 2020. "Unintended Consequences of Products Liability: Evidence from the Pharmaceutical Market [“An Economic Analysis of Mary Carter Settlement Agreements,”]," The Journal of Law, Economics, and Organization, Oxford University Press, vol. 36(3), pages 598-632.
    11. Francesco Decarolis, 2012. "Pricing and Incentives in Publicly Subsidized Health Care Markets: the Case of Medicare Part D," PIER Working Paper Archive 12-026, Penn Institute for Economic Research, Department of Economics, University of Pennsylvania.
    12. Rabbani, Maysam, 2023. "Mergers with future rivals can boost prices, bar entry, and intensify market concentration," International Journal of Industrial Organization, Elsevier, vol. 88(C).
    13. Sanzenbacher, Geoffrey T. & Wettstein, Gal, 2020. "Drug insurance and the strategic behavior of drug manufacturers: Evergreening and generic entry after Medicare Part D," Journal of Health Economics, Elsevier, vol. 72(C).
    14. Jakub P. Hlávka & Jeffrey C. Yu & Dana P. Goldman & Darius N. Lakdawalla, 2021. "The economics of alternative payment models for pharmaceuticals," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(4), pages 559-569, June.
    15. Claudio Lucarelli & Sean Nicholson & Minjae Song, 2010. "Bundling Among Rivals: A Case of Pharmaceutical Cocktails," NBER Working Papers 16321, National Bureau of Economic Research, Inc.
    16. Robin McKnight & Jonathan Reuter & Eric Zitzewitz, 2012. "Insurance as Delegated Purchasing: Theory and Evidence from Health Care," NBER Working Papers 17857, National Bureau of Economic Research, Inc.
    17. Decarolis, Francesco, 2015. "The unintended effects of the Medicare Part D low income subsidy," Health Policy, Elsevier, vol. 119(5), pages 597-603.
    18. Soetevent, Adriaan & Hinloopen, Jeroen, 2016. "(Non-)Insurance Markets, Loss Size Manipulation and Competition," Research Report 16009-EEF, University of Groningen, Research Institute SOM (Systems, Organisations and Management).
    19. Daniel Hosken & David Schmidt & Matthew C. Weinberg, 2020. "Any Willing Provider and Negotiated Retail Pharmaceutical Prices," Journal of Industrial Economics, Wiley Blackwell, vol. 68(1), pages 1-39, March.
    20. Chen, Hua & Ding, Yugang & Wang, Xiangnan & Yang, Yifei, 2023. "The effect of public insurance policy on the private insurance market: New evidence from a quasi-experiment in China," Economic Analysis and Policy, Elsevier, vol. 78(C), pages 937-953.

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    Keywords

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    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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