L’atelier médicament est un espace libre de présentation et de discussion entre économistes de la santé et décideurs dans le domaine du médicament et des dispositifs médicaux.
La première séance de l’Atelier Médicaments aura lieu le jeudi 12 mai de 17 à 19h à l’Hôtel-Dieu (Amphi Dupuytren), Paris. Le programme est le suivant :
Première Présentation: “Efficient and fair pricing of medicines in an unequal world: who should pay for R&D?”
Présentateur : Bruno Versaevel, Emlyon business school & GATE UMR 5824
Co-auteurs: Etienne Billette de Villemeur, Université de Lille & LEM UMR 9221
Vianney Dequiedt, Université Clermont Auvergne & CERDI UMR 6587
We consider a firm which, if successful in R&D, supplies a patented medicine in two countries with different per-capita incomes. When information on local market conditions is limited, we investigate a pricing policy with “prioritization” that (i) addresses equity concerns to the benefit of the low-income population, (ii) can be implemented without penalizing high-income consumers, and (iii) comes close to the social optimum. We characterize second-best price solutions in terms of access effort, defined for any level of income inequalities as the marginal effect on the deadweight loss, per unit of medicine, of increasing the price in a given country. Although our results include cases where the risk-adjusted R&D fixed cost is entirely paid by the high-income population, we also identify circumstances where it is the low-income country that makes R&D supportable globally. However, the access effort in that country remains lower than with standard Ramsey pricing, while high-income consumers never pay more for the medicine than in a counterfactual world without low-income market. Whether the firm behaves as prescribed by the proposed pricing policy can be monitored by only verifying ex-post that the consolidated net profit is equal to zero.
Deuxième Présentation: “Hospital payment schemes and high-priced drugs: Evidence from the French Add-on List”
Présentatrice : Lise Rochaix, Université Paris 1 & Hospinnomics
Co-auteurs: Laurie Rachet-Jacquet, Centre for Health Economics, University of York
Léa Toulemon, Institut des Politiques Publiques, Paris School of Economics
Under prospective payment schemes, hospitals may be disincentivised to use high-priced drugs. In this context, supplementary payment schemes have been implemented to fund hospitals beyond hospital tariffs for the use of such technologies. In France, since 2004, an add-on list scheme ensures that listed high-priced drugs are reimbursed by the state, thereby imposing no cost on hospitals while drugs are on the list. Yet little is known about the impact of drug delisting, i.e., when drugs are removed from the add- on list, on hospital utilisation. In this paper, we investigate the effects of delisting for 12 cancer drugs on the volumes prescribed, the generic shares and the purchase prices negotiated by hospitals. Using French hospital-level data over the period 2008-2016, we construct volumes, generic shares and purchase prices at the molecule level to account for potential substitutions across therapeutically equivalent drugs. Hospital fixed effects allow for time-invariant unobserved hospital heterogeneity linked to e.g., prescription preferences or hospitals’ bargaining power. Our results indicate that prescription volumes, generic shares and price levels are not systematically affected by delisting, nor do we find evidence of response heterogeneity by hospital type. Overall, our findings mitigate concerns that the financial incentives associated with add-on lists may lead to hospitals over-prescribing high-priced drugs.
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