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Determinants of branded prescription medicine prices in OECD countries

Published online by Cambridge University Press:  11 May 2011

Panos G. Kanavos  and
Sotiris Vandoros
Panos G. Kanavos*
Affiliation:
Reader Lecturer in International Health Policy, Department of Social Policy and LSE Health, London School of Economics, UK
Sotiris Vandoros
Affiliation:
Postdoctoral Research Officer, LSE Health, London School of Economics, UK
*
*Correspondence to: Panos G. Kanavos, LSE Health, Cowdray House, London School of Economics, Houghton Street, London WC2A 2AE, UK. Email: [email protected]
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Abstract

This paper investigates the determinants of the prices of branded prescription medicines across different regulatory settings and health care systems, taking into account their launch date, patent status, market dynamics and the regulatory context in which they diffuse. By using volume-weighted price indices, this paper analyzes price levels for a basket of prescription medicines and their differences in 15 OECD countries, including the United States and key European countries, the impact of distribution margins and generic entry on public prices and to what extent innovation, by means of introducing newer classes of medicines, contributes to price formation across countries. In doing so, the paper seeks to understand the factors that contribute to the existing differences in prices across countries, whether at an ex-factory or a retail level. The evidence shows that retail prices for branded prescription medicines in the United States are higher than those in key European and other OECD countries, but not as high as widely thought. Large differences in prices are mainly observed at an ex-factory level, but these are not the prices that consumers and payers pay. Cross-country differences in retail prices are actually not as high as expected and, when controlling for exchange rates, these differences can be even smaller. Product age has a significant effect on prices in all settings after having controlled for other factors. Price convergence is observed across countries for newer prescription medicines compared with older medicines. There is no evidence that originator brand prices fall after generic entry in the United States, a phenomenon known as the ‘generics paradox’. Finally, distribution and taxes are important determinants of retail prices in several of the study countries. To the extent that remuneration of the distribution chain and taxation are directly and proportionately linked to product prices this is likely to persist over time.

Type
Articles
Information
Health Economics, Policy and Law , Volume 6 , Issue 3 , 16 June 2011 , pp. 337 - 367
Copyright
Copyright © Cambridge University Press 2011

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References

Aaserud, M., Dahlgren, A. T., Kösters, J. P., Oxman, A. D., Ramsay, C.Sturm, H. (2009), ‘Pharmaceutical policies: effects of reference pricing, other pricing, and purchasing policies’, The Cochrane Library, (3): 1–44.Google Scholar
Aronsson, T., Bergman, M. A.Rudholm, N. (2001), ‘The impact of generic competition on brand name market shares – empirical evidence from micro data’, Review of Industrial Organization, 19: 425–435.CrossRefGoogle Scholar
Berndt, E. R., Griliches, Z., Rosett, J. G. (1992), ‘Auditing the Producer Price Index: Micro Evidence from Prescription Pharmaceutical Preparations’, Cambridge, Massachusetts: NBER Working Papers Series.Google Scholar
Berndt, E. R., Danzon, P. M.Kruse, G. B. (2007), ‘Dynamic competition in pharmaceuticals: cross-national evidence from new drug diffusion’, Managerial and Decision Economics, 28: 231–250.CrossRefGoogle Scholar
Berndt, E. R., Bui, L., Reiley, D. R.Urban, G. L. (1995), ‘Information, marketing, and pricing in the U.S. Antiulcer Drug Market’, American Economic Review: Papers and Proceedings, 85: 100–105.Google ScholarPubMed
Caves, R. E., Whinston, M. D., Hurwitz, M. A. (1991), ‘Patent Expiration, Entry and Competition in the US Pharmaceutical Industry’, Brookings Papers on Economic Activity, Washington, DC: Brookings Institution Press.CrossRefGoogle Scholar
Congressional Budget Office (CBO) (1998), How Increased Competition from Generic Drugs Has Affected Prices and Returns in the Pharmaceutical Industry, Washington, DC: CBO.Google Scholar
Congressional Budget Office (CBO) (2005), Prices for Brand-Name Drugs Under Selected Federal Programs, Washington, DC: CBO.Google Scholar
Congressional Budget Office (CBO) (2008), Increasing Transparency in the Pricing of Health Care Services and Pharmaceuticals. Economic and Budget Issues Brief, Washington, DC: CBO.Google Scholar
Dalen, D. M., Strom, S.Haabeth, T. (2006), ‘Price regulation and the generic competition in the pharmaceutical market’, European Journal of Health Economics, 7: 208–214.CrossRefGoogle ScholarPubMed
Danzon, P. M.Chao, L.-W. (2000a), ‘Cross national price differences for pharmaceuticals: how large and why?’, Journal of Health Economics, 19: 159–195.CrossRefGoogle ScholarPubMed
Danzon, P. M.Chao, L.-W. (2000b), ‘Does regulation drive out competition in pharmaceutical markets?’, Journal of Law & Economics, 43: 311–357.CrossRefGoogle Scholar
Danzon, P. M.Towse, A. (2003), ‘Differential pricing for pharmaceuticals: reconciling access, R&D and patents’, International Journal of Health Care Finance and Economics, 3: 183–205.CrossRefGoogle ScholarPubMed
Danzon, P. M.Furukawa, M. F. (2003), ‘Prices and availability of pharmaceuticals: evidence from nine countries’. Health Affairs, July–December; Suppl Web Exclusives: W3-521-36. doi:10.1377/hthaff.w3.521Google Scholar
Danzon, P. M.Furukawa, M. F. (2008), ‘International prices and availability of pharmaceuticals in 2005’, Health Affairs, 27(1): 221–233.CrossRefGoogle ScholarPubMed
Danzon, P. M., Wang, Y. R.Wang, L. (2005), ‘The impact of price regulation on the launch delay of new drugs’, Journal of Health Economics, 14(3): 269–292.CrossRefGoogle ScholarPubMed
Department of Health (1997), The Pharmaceutical Price Regulation Scheme: Second Report to Parliament, United Kingdom: Department of Health.Google Scholar
Department of Health (2009), The Pharmaceutical Price Regulation Scheme: Tenth Report to Parliament, United Kingdom: COI for the Department of Health.Google Scholar
Desiraju, R., Nair, H.Chintagunta, P. (2004), ‘Diffusion of new pharmaceutical drugs in developing and developed nations’, International Journal of Research in Marketing, 21: 341–347.CrossRefGoogle Scholar
Espin, J., Rovira, J., Olry de Labry, A. (2010), ‘Policy Paper on External Reference Pricing’, WHO/HAI Project on Medicines Prices and Availability, The Netherlands, Geneva and HAI: WHO.Google Scholar
Frank, R. G.Salkever, D. S. (1997), ‘Generic entry and the pricing of pharmaceuticals’, Journal of Economics & Management Strategy, 6(1): 75–90.Google Scholar
General Accounting Office (GAO) (1995), Prescription Drug Prices: Official Index Overstates Producer Price Inflation. GAO Report, vol. 90, Washington, DC: GPO.Google Scholar
General Accounting Office (GAO) (1996), Health Care: Opportunities to Reduce Outpatient Pharmacy Costs. GAO Report, vol. 162, Washington, DC: GPO.Google Scholar
General Accounting Office (GAO) (2009), Brand-name prescription drug pricing: Lack of therapeutically equivalent drugs and limited competition may contribute to extraordinary price increases. GAO-10-201, December 22, Washington, DC: GPO.Google Scholar
Grabowski, H.Vernon, J. (1986), ‘Longer patents for lower imitation barriers: The 1984 Drug Act’, The American Economic Review, 76(2): 195–198.Google Scholar
Grabowski, H. G.Vernon, J. M. (1996), ‘Brand loyalty, entry and price competition in pharmaceuticals after the 1984 Drug Act’, Journal of Law and Economics, 35(2): 331–350.Google Scholar
Grootendorst, P.Stewart, D. (2006), ‘A re-examination of the impact of reference pricing on anti-hypertensive drug plan expenditure in British Columbia’, Health Economics, 15: 735–742.CrossRefGoogle ScholarPubMed
Jönsson, B. (1994), ‘Pricing and reimbursement of pharmaceuticals in Sweden’, Pharmacoeconomics, 6 Supplement 1: S51–S60.CrossRefGoogle ScholarPubMed
Kanavos, P.Mossialos, E. (1999), ‘International comparisons of health care expenditures: what we know and what we do not know’, Journal of Health Services Research and Policy, 4(2): 122–126.CrossRefGoogle Scholar
Kanavos, P.Costa-Font, J. (2005), ‘Pharmaceutical parallel trade in Europe: stakeholder and competition effects’, Economic Policy, 20(44): 751–798.Google Scholar
Kanavos, P., Costa-Font, J.McGuire, A. (2007), ‘Product differentiation, competition and regulation of new drugs: the case of statins in four European countries’, Managerial and Decision Economics, 28: 455–465.CrossRefGoogle Scholar
Kanavos, P., Costa-Font, J.Seeley, E. (2008), ‘Competition in off-patent drug markets: issues, regulation and evidence’, Economic Policy, 55: 498–539.Google Scholar
Kanavos, P., Seeley, E., Vandoros, S. (2009). ‘Tender Systems for Outpatient Pharmaceuticals in the European Union: Evidence from the Netherlands, Germany and Belgium’, Brussels: European Commission, DG Enterprise and European Medicines Information Network (EMINet).Google Scholar
Kanavos, P., Manning, J., Taylor, D., Schurer, G. W.Checchi, K. (2010), Implementing Value-Based Pricing for Pharmaceuticals in the UK, London: 2020 Health.Google Scholar
Kanavos, P., Nicod, E., Espin, J., van den Aardweg, S., Pomedli, S. (2011a), ‘Short- and Long-term Effects of Value-based Pricing Versus External Price Referencing’, Brussels: European Commission, DG Enterprise and European Medicines Information Network (EMINet).Google Scholar
Kanavos, P., Schurer, G. W., Vogler, S. (2011b), ‘The Pharmaceutical Distribution Chain in the European Union: Structure and Impact on Pharmaceutical Prices’, Brussels: European Commission, DG Enterprise and European Medicines Information Network (EMINet).Google Scholar
Kyle, K. M. (2007), ‘Pharmaceutical price controls and entry strategies’, Review of Economics and Statistics, 89(1): 88–99.CrossRefGoogle Scholar
Lanjouw, J. O. (2005), ‘Patents, Price Controls and Access to New Drugs: How Policy Affects Global Market Entry’, Working Paper, Agricultural and Resource Economics Department, University of California, Berkeley, CA.Google Scholar
Lexchin, J. (2004), ‘The effect of generic competition on the price of brand-name drugs’, Health Policy, 68(1): 47–54.CrossRefGoogle Scholar
Light, D. W. (2009), ‘Global drug discovery: Europe is ahead’, Health Affairs, Web Exclusive, 28(5): w969–w977.Google Scholar
Light, D. W.Lexchin, J. (2005), ‘Foreign free riders and the high price of US medicines’, British Medical Journal, 331: 958–960.Google Scholar
Magazzini, L., Pammolli, F.Riccaboni, M. (2004), ‘Dynamic competition in pharmaceuticals. Patent expiry, generic penetration and industry structure’, European Journal of Health Economics, 5(2): 1598–1618.Google ScholarPubMed
McClellan, M. (2003), ‘Commentary – drug R&D: must Americans always pay?’, Business Week, October 13.Google Scholar
Mujumdar, S.Pal, D. (2005), ‘Do price ceilings abroad increase US drug prices?’, Economics Letters, 87: 9–13.CrossRefGoogle Scholar
Österreichisches Bundesinstitut für Gesundheitswesen (ÖBIG) (2007), ‘Pharmaceutical Pricing and Reimbursement Information (PPRI)’, http://ppri.oebig.at/index.aspx?Navigation=r%7C2%7C0- [10 December 2008].Google Scholar
Productivity Commission (2001), International Pharmaceutical Price Differences, Research Report, Canberra, Australia: Productivity Commission.Google Scholar
Rizzo, J. A. (1999), ‘Advertising and competition in the ethical pharmaceutical industry: the case of antihypertensive drugs’, Journal of Law and Economics, 42(1): 89–116.Google Scholar
Rizzo, J. A., Zeckhauser, R. (2005), ‘Generic Script Share and the Price of Brand-Name Drugs: The Role of Consumer Choice’, Cambridge, Massachusetts: NBER Working Paper 11431.Google Scholar
Roughead, E. E., Lopert, R.Sansom, L. N. (2007), ‘Prices for innovative pharmaceutical products that provide health gain: a comparison between Australia and the United States’, Value in Health, 10: 514–520.Google Scholar
Sorenson, C., Drummond, M., Kanavos, P. (2008), ‘Ensuring Value for Money in Health Care: The Role of HTA in the European Union’, Financing Sustainable Healthcare in Europe: New Approaches for New Outcomes, European Observatory on Health Systems and Policies, Buckingham: Open University Press.Google Scholar
Spurling, G. K., Mansfield, P. R., Montgomery, B. D., Lexchin, J., Doust, J., Othman, N.Vitry, A. I. (2010), ‘Information from pharmaceutical companies and the quality, quantity and cost of physicians’ prescribing: a systematic review’, PLoS Medicine, 7(10): e1000352.CrossRefGoogle ScholarPubMed
Verbeek, M. (2005), ‘A guide to modern econometrics’, John Wiley and Sons, New York, Second Edition.Google Scholar
World Health Organization ATC/DDD Index (2008), http://www.whocc.no/atcddd [November 2008].Google Scholar