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Beyond Patient Prices: Multi-Stakeholder Responses and Behavioral Spillovers from Japan's Brand-Name Drug Surcharge

Author

Listed:
  • Go Nakatsui

    (Research Center for Advanced Policy Studies, Institute of Economic Research, Kyoto University)

  • Fumio Ohtake

    (Research Center for Advanced Policy Studies, Institute of Economic Research, Kyoto University, Center for Infectious Disease Education and Research, Osaka University)

  • Reo Takaku

    (Graduate School of Economics, Hitotsubashi University)

  • Naoto Tanemoto

    (Policy Research Institute, Ministry of Finance, Japan)

Abstract

Cost-sharing reforms can shift behavior beyond the patients who pay. Using 180 million pharmacy dispensing claims, we study Japan's 2024 surcharge on brand-name drugs with generic alternatives. Generic dispensing increased in both surcharge-eligible and exempt categories, 1.92 pp more in eligible categories. Responses extended beyond own-price incentives: generic-name prescribing increased despite physicians not bearing the charge; dispensing responses showed no monotonic gradient in surcharge amounts; and generic adoption spilled over to exempt categories (+3.85 pp), concentrated among the most-exposed patients and physicians. Targeted cost-sharing can shift defaults across stakeholders beyond its formal scope, and reporting requirements can change prescribing behavior.

Suggested Citation

  • Go Nakatsui & Fumio Ohtake & Reo Takaku & Naoto Tanemoto, 2026. "Beyond Patient Prices: Multi-Stakeholder Responses and Behavioral Spillovers from Japan's Brand-Name Drug Surcharge," KIER Working Papers 1130, Kyoto University, Institute of Economic Research.
    • Handle: RePEc:kyo:wpaper:1130
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    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • D91 - Microeconomics - - Micro-Based Behavioral Economics - - - Role and Effects of Psychological, Emotional, Social, and Cognitive Factors on Decision Making
    • L51 - Industrial Organization - - Regulation and Industrial Policy - - - Economics of Regulation

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