Search results

With expenditures totaling $227 billion in 2007, prescription drug purchases are a growing portion of the total medical expenditure, and as this industry continues to grow, prescription drugs will continue to be a critical part of the larger health care industry. This chapter presents a survey on the economics of the US pharmaceutical industry, with a focus on the role of R&D and marketing, the determinants (and complications) of prescription drug pricing, and various aspects of consumer behavior specific to this industry, such as prescription drug regulation, the patient's interaction with the physician, and insurance coverage. This chapter also provides background in areas not often considered in the economics literature, such as the role of pharmacy benefit managers in prescription drug prices and the differentiation between alternative measures of prescription drug prices.

The purpose of this paper is to identify and examine the major forces that are changing the way biopharmaceutical medications are purchased, distributed, and sold throughout the supply chain. This will become important as healthcare reform moves forward, and logistics will be transformed in this industry.

Multiple interviews with key informants at each level of the value chain were combined with manifest text analysis from practitioner articles to derive key insights into the primary change drivers influencing the future of the biopharmaceutical supply chain.

The research discovered radical shifts in the structure of the biopharmaceutical supply chain. Future research into biopharmaceutical supply chain practices will need to explore three primary issues: How will supply chain member compensation influence the power of parties within the network? How will the role of supply chain intermediaries change the landscape of medication delivery to the end customer? What impact will the role of regulatory constraints on product pedigree and proliferation have on this network? The relationship between these forces is mediated by operations strategy concerning inventory policy, supply chain visibility, and desired service levels.

The research was based on multiple interviews with a convenience sample, as well as text analysis from practitioner articles. These findings are an initial step to guide future more in‐depth research for this dynamic and contextually rich supply chain environment that impacts consumers in every country in the world.

The paper adds insights into the pharmaceutical supply chain, examining this from multiple perspectives.

Objective – To examine whether local area pharmacy market structure influences contract terms between prescription drug plans (PDPs) and pharmacies under Part D.

Data – Data were collected and compiled from four sources: a national mail survey to independent pharmacies, National Council for Prescription Drug Programs (NCPDP) Pharmacy database, 2000 U.S. Census data, and 2006 Economic Census data.

Results – Reimbursements varied substantially across pharmacies. Reimbursement for 20mg Lipitor (30 tablets) ranged from $62.40 to $154.80, and for 10mg Lisinopril (30 tablets), it ranged from $1.05 to $18. For brand-name drug Lipitor, local area pharmacy ownership concentration had a consistent positive effect on pharmacy bargaining power across model specifications (estimates between 0.084 and 0.097), while local area per capita income had a consistent negative effect on pharmacy bargaining power across specifications(−0.149 to −0.153). Few statistically significant relationships were found for generic drug Lisinopril.

Conclusion – Significant variation exists in PDP reimbursement and pharmacy bargaining power with PDPs. Pharmacy bargaining power is negatively related to the competition level and the income level in the area. These relationships are stronger for brand name than for generics. As contract offers tend to be non-negotiable, variation in reimbursements and pharmacy bargaining power reflect differences in initial insurer contract offerings. Such observations fit Rubinstein's subgame perfect equilibrium model.

Implication – Our results suggest pharmacies at the most risk of closing due to low reimbursements are in areas with many competing pharmacies. This implies that closures related to Part D changes will have limited effect on Medicare beneficiaries’ access to pharmacies.

The purpose of this paper is to explain the rationale and methodology applied to the rental valuation of wet led (i.e. pub or bar) retail leisure outlets. The paper does not cover the valuation of other leisure property (e.g. restaurants, hotels).

The paper opens with a brief outline of the factors and legislative changes which have shaped the public house market over the past 15 years. This is followed by a explanation of the rental valuation methods in use in the pub and bar sector and examination of the impact of some current issues – in particular the impact of the full implementation of the Licensing Act 2003 along with other legislative and regulatory changes. Finally the paper comments on some of the issues relevant to freehold investment purchases of public houses and bars.

As a consequence of the nature of the industry, profits based valuations continue to dominate the market and this raises difficult questions of method and interpretation particularly, as the market is further complicated by legislative and regulatory changes introducing greater uncertainty. With regard to public house and bar freehold investment changes in the structure of the market have had a significant impact on perceptions of the investment quality of the leisure sector with consequences both for flows of capital and the structure of yields in the market place.

Valuers need to be aware that freehold investment values in this sector have potentially peaked and that investment decisions in the sector should be based upon sustainable rent.

The paper is of use to all valuers in this niche market and provides a practical understanding of the profits test method of valuation from which a sustainable rent may be derived.

In Canada, grain handling is an important agri-business that has traditionally been cooperative in nature (for example, Saskatchewan Wheat Pool). At the same time the industry is heavily regulated. There has been a dramatic change in the structure of the industry over the past 20 years and there are currently no major cooperatives present in the market. If the “yardstick effect” hypothesis of the role of cooperatives in an imperfectly competitive market is true, the disappearance of cooperatives could result in the ability of remaining firms to exercise market power over producers. To investigate the impact of changes in ownership structure in the market, we estimated two types of pricing games that might have been played between a cooperative, Saskatchewan Wheat Pool (SWP) and an investor-owned firm (IOF), Pioneer Grain (PG) in the Saskatchewan wheat-handling market over the period 1980–2004, with different assumptions about their pricing behavior imposed. We find that SWP and PG have likely been playing a Bertrand pricing game in the market over the period. We thus conclude that SWP, as the largest cooperative in the market, likely played a “yardstick effect” role in the market.

The case tells the story of Synthroid from its development in 1958 as the first synthetic thyroxine molecule to its competition against generic equivalents in 2004. The case introduces students to the pharmaceutical industry, its practices, and some of the complexities of pricing and drug choice, with drug manufacturers, insurance companies, physicians, pharmacists, and patients all playing a role. It also provides a primer on hypothyroidism, its symptoms, and its treatment.

Because Synthroid was developed and introduced before FDA regulations and drug standards of identity were fully established, it was difficult for competitors to get their drugs certified as identical to Synthroid. Through a series of efforts with physicians, especially endocrinologists, Synthroid's owners were able to maintain the perception for forty-six years that Synthroid was uniquely effective. In 2004, however, the FDA declared several competitive products to be bioequivalent to Synthroid, which posed a significant challenge to its owner, Abbott Laboratories. Students are challenged to consider options to maintain the drug's unit volume, revenue, and/or profit in these difficult circumstances.

The case is written in two parts. The (A) case provides background on the history of the drug, the pharmaceutical industry and its marketing practices, and hypothyroidism and its treatment, and it concludes in 2004 as Abbott's marketers face the impending challenge of defending the Synthroid business against generic competition. The (B) case describes what Abbott actually did to maintain its share in the United States and outlines its strategy in India, a market without patent protection for pharmaceuticals.

After analyzing the case students should be able to:

• Describe strategies that branded competitors can use to defend their business from lower-priced competition

• Understand the basics of pharmaceutical marketing and pricing, including the global challenge of defending branded drugs against generic equivalents

• Discuss ethical issues in the marketing of high-margin branded products that have lower-priced alternatives, especially in the healthcare industry

Describe strategies that branded competitors can use to defend their business from lower-priced competition

Understand the basics of pharmaceutical marketing and pricing, including the global challenge of defending branded drugs against generic equivalents

Discuss ethical issues in the marketing of high-margin branded products that have lower-priced alternatives, especially in the healthcare industry