This paper seeks to empirically identify the major factors that influence physician loyalty behavior in prescribing certain brands of drugs.
Testable hypotheses were developed with respect to physician loyalty behavior regarding drug prescription practices, and a survey questionnaire was designed to capture the data from 71 physicians, as a convenience sample. The hypotheses were tested by PLS path modeling.
The major finding is that tangible rewards to physicians by the pharmaceutical companies lead to prescription loyalty. The second major finding is that the professional values of pharmaceutical sales representatives (PSR) impact significantly on physician prescription loyalty. The hypotheses related to the impact of PSR personality, drug quality, corporate reputation and professional influence on prescription loyalty were not supported in the study.
The results should prove useful to pharmaceutical companies in developing physician loyalty to particular brands as well as enhancing the understanding of drug control authorities and governmental health policy makers, in controlling unethical medical practices by physicians.
This paper reports an original empirical study on physician loyalty behavior in the context of drug prescription.
The purpose of this paper is to examine reported literature on the influence of medical representatives (MRs) and other promotional tools on drug prescribing behaviour…
The purpose of this paper is to examine reported literature on the influence of medical representatives (MRs) and other promotional tools on drug prescribing behaviour, and to assess whether this effect is different in developed and developing countries.
A survey of the literature was conducted across online databases from 2000 to 2016. Eligible studies addressed MRs and other promotion tools used to influence drug prescribing in developed and developing countries.
A total of 40 reviewed studies met the inclusion requirements. In total, 22 of the studies were conducted in developed countries and 18 in developing countries. Out of ten studies that examined the influence of MRs on drug prescribing in developed countries, eight found a positive influence, one found only moderate and one finds no influence. Analogous results were found in developing countries. Six out of ten studies on the influence of MRs conducted in developing countries found a positive effect, three found only moderate effects, while one finds no influence. The influence of promotion tools on prescribing varied in developed countries, five found positive influence, four reported a small effect and one found negative influence. In developing countries, the size of effect also varied, five studies found positive influence of promotion tools on drug prescribing behaviour, five found a negligible or small effect, and one found no association. However, marked differences were observed between two sectors. In the developed countries, MRs are valued as a source of information and can have an effect on prescribing, while it is unreliable in developing countries. Sample drugs are more generally seen as an important promotional tool for prescribing in developed countries than developing countries.
The results derived from this review are based on studies with varying methodological consistency. The review provides the crucial information that will be valuable to researchers working on comparative analysis of marketing efforts in developing and developed countries.
This paper is one of the few systematic reviews on the influence of MRs and other promotional tools on prescribing. It compares the influence of MRs and promotional efforts in both developed and developing countries.
The role of patient’s characteristics in the prescribing decision of physicians comprises two major constructs: drug request and expectations. The purpose of this paper…
The role of patient’s characteristics in the prescribing decision of physicians comprises two major constructs: drug request and expectations. The purpose of this paper was to examine the existing literature on patient characteristics and then explore the circumstances that reinforce the connection between patient characteristics (drug requests and expectations) and physician prescribing decision.
A survey of the literature was carried out across online databases from 1994 to 2015, and 25 reviewed articles were identified. The influence of patient factors on physician prescribing decisions was identified in the articles. A conceptual model to investigate the patient characteristics that influence physicians’ prescribing decision was the developed.
There have been numerous studies on the effect of patient characteristics on physician prescription decision. Some studies discovered patient’s request for drug and expectations strongly influence physicians’ prescribing decision, whereas others found only minor or no relation. To resolve this ambiguity, there is a need to precisely understand how patient factors affect prescribing decisions of physicians, under different contexts and conditions. This review contends that contextual variables – drug characteristics, drug cost/benefits ratio and physician habit persistence – are determining factors in this debate.
The study recommends further studies on the influence of each factor on physician prescribing behaviour and an evaluation of the proposed model and moderating variables.
This paper is the first significant step towards recognizing contextual variables that may moderate the relationship between a patient’s drug request and expectations and prescribing behaviour. This research contributes to resolving the debate on the ways patient factors affect prescribing behaviour.
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…
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.
- Abbreviated New Drug Application (ANDA)
- Average Manufacturer Price (AMP)
- Average Wholesale Price (AWP)
- Bayh-Dole Act
- Brand name drug
- Center for Medicare and Medicaid Services (CMS)
- Chain pharmacy
- Clinical trials
- Closed formulary
- Cost controls
- Cost sharing
- Direct-to-consumer Advertising (DTC Advertising)
- Disease management
- Drug manufacturers
- Drug prices
- Drug–product substitution
- Experience goods
- Fee-for-service (FFS)
- First-mover advantage
- Food and Drug Administration (FDA)
- Generic drug
- Good Manufacturing Processes (GMP)
- Hatch-Waxman Act
- Health plan
- Investigational New Drug Application (IND)
- Mail-order pharmacy
- Mail-order prescription drugs
- Medicare+Choice (M+C)
- Medicare Advantage
- Medicare Modernization Act (MMA)
- Medicare Part D
- Moral hazard
- Negative goods
- New Drug Application (NDA)
- Non-retail pharmacy
- Original Medicare
- Paid search advertising
- Pharmacy benefit manager (PBM)
- Prescription drugs
- Product differentiation
- Research and development (R&D)
- Retail pharmacy
- Search costs
- Switching costs
- Therapeutic class
- Third-party insurance
- Tiered formulary
- Wholesale Acquisition Price (WAC)
The purpose of this paper is to estimate whether health maintenance organizations (HMO) physicians are more price sensitive than non‐HMO physicians in their prescribing…
The purpose of this paper is to estimate whether health maintenance organizations (HMO) physicians are more price sensitive than non‐HMO physicians in their prescribing behavior of brand‐name substitutes.
The study uses physician level data and a set of 13 drugs for the years 1997‐2000 to estimate the price sensitivity of HMO and non‐HMO physicians. A two‐part model is used to measure the price elasticity of brand‐name prescribing for HMO physicians. The first part uses a logit model to examine the physician's choice to prescribe the same drug to all patients with the same medical condition, or whether physicians alternate prescriptions among brand‐name substitutes. The second part employs OLS to estimate the influence of managed care, i.e. HMOs, on physician price sensitivity.
The results suggest that HMO physicians are less likely than non‐HMO physicians to prescribe a common drug to all patients with a specific medical condition, but rather HMO physicians exhibit more diversified prescribing behavior. Correspondingly, HMO physicians are more price sensitive in prescribing brand‐name substitutes, than non‐HMO physicians, exhibiting price elasticities of prescribing ranging from −1.707 to −1.823. The analysis suggests that HMOs have a modest influence on encouraging physicians to be more price sensitive in their prescribing of brand‐name substitutes. HMO physicians are more price sensitive in their prescribing behavior than non‐HMO physicians.
This paper provides insight into the effectiveness of HMOs in altering physician prescribing behavior and price sensitivity of pharmaceutical prices. The results provide suggestions on how HMOs can improve the cost‐effectiveness of physician prescribing behavior.
Many people in developing countries are suffering from serious diseases, such as HIV and tuberculosis. On the other hand, drug patents impact the availability of the drug for patients. Pharmaceutical technology transfer is widely used by domestic and foreign pharmaceutical enterprises because it promotes the availability of the drug for patients. The purpose of this paper, which is on drug technology transfer, is mainly to discuss how to solve the conflict between drug patent protection and public health from the perspective of the law, but not from the perspective of economics. To fill this gap, the authors introduce a model in the prescription drug market and analyze how a foreign manufacturer that produces brand name drugs authorizes a domestic enterprise that produces common drugs.
In this paper, the authors consider a situation that if the patent holders are provided a certain amount of compensation, then whether compulsory licensing would be an effective tool to promote competition and improve the availability of drugs. Furthermore, they also consider three different cooperation mechanisms, namely, fixed-fee contract, royalty contract and two-part tariff contract, under the case of technology transfer and give the condition of which contract would be better under different scenarios.
It is found that the product differentiation and the agent behavior of doctor in the domestic market have a deep impact on the foreign enterprise’s decision on technology transfer. If both fixed-fee contract and royalty contract are permitted, foreign enterprise will choose different transfer contracts under different conditions. Under two-part tariff contract, it is equivalent to a fixed-fee or royalty contract under certain conditions. Furthermore, all contracts can improve patients’ benefits, while the royalty contract and the two-part tariff contract would reduce importer’s social welfare under certain conditions.
Prescription drugs can treat many acute diseases and improve people’s quality of life. On the other hand, it requires investment in pharmaceutical research and development and is hard to afford the drug for the people living in poverty. This paper tries to solve the problem by introducing three cooperation contracts. The authors consider an innovative drug company and a regular drug company. The regular drug company can improve the quality of its drug by signing a technology transfer agreement with the innovative company. Three contracts are discussed in this paper; they are fixed-fee contract, royalty contract and two-part tariff contract. The authors examine the impact of different contracts on the companies’ profit, patients’ benefit and social welfare. It is found that quality differentiation of drugs and doctor behaviors can have large impacts on the company’s decision about technology adoption as well as contract choice strategies. In all of the three contracts, patients’ benefit improves, while the profit of the two companies and social welfare can increase or decrease under different contracts.
This paper aims to study the post-patent ethical drug market and simulate the impact of Patient Protection and Affordable Care Act (ACA) on individuals, health-care…
This paper aims to study the post-patent ethical drug market and simulate the impact of Patient Protection and Affordable Care Act (ACA) on individuals, health-care providers and pharmaceutical firms. US policymakers have been looking at various ways to curb rising health-care costs in USA, including ways to promote the use of generic drugs in lieu of brand drugs. In this broader context, the implementation of ACA in December 2013 will introduce major changes in the pharmaceutical market.
To fully understand the impact of such policy changes, we develop a structural model to study consumers’ buying behavior and firm competition in the post-patent ethical drug markets. We use the estimated model parameters to conduct four policy simulations to illustrate the effect of Obamacare on increasing the relative size of price-insensitive segment, reducing price sensitivity in the price-sensitive segment, providing brand price discount to Medicare patients previously in the “donut hole” and the effect of change in people’s attitude toward generics.
Our model estimation reveals two classes of consumers with different price sensitivities. This heterogeneity explains the increase in the brand price after generic entry. We identify consumers’ switching costs between generic and brand drugs, as well as among different generics. From the policy simulation, we find that except the closure of Medicare donut hole, all other policy changes lead to increased usage of the focal molecule, and the efforts to increase insurance coverage and reduce the out of pocket payment for prescription drugs lead to increase in firm profit.
This paper is the first to illustrate the potential policy effect of Obamacare through a structural model on post-patent ethical drug market.
The purpose of this paper is to determine if dually diagnosed (DDx) patients with severe mental illnesses such as bipolar disorder and schizophrenia are at higher risk of…
The purpose of this paper is to determine if dually diagnosed (DDx) patients with severe mental illnesses such as bipolar disorder and schizophrenia are at higher risk of not obtaining prescribed medication.
National Veterans Health Administration records from 2010 identified all DDx patients with Bipolar (BP) spectrum (n=98,894) and Schizophrenia (SZ) spectrum (n=80,654) disorders. Pharmacy records identified the total number of prescriptions dispensed per veteran for antidepressants, antipsychotics, sedative‐hypnotics and anxiolytics, mood stabilizers (anti‐convulsants), and lithium. To identify potential sociodemographic and clinical confounders, bivariate analyses compared four groups: BP and SZ with and without DDx. Analysis of covariance (ANCOVA) was used to determine the association of DDx with the number of dispensed prescriptions, and interaction analysis was used to determine whether any “dual‐diagnosis effect” was greater between BP or SZ. Further ANCOVA examined whether significant differences were accounted for by differences in outpatient mental health visits or co‐morbidities.
Among BP veterans, 33,226 (33.6 percent) were DDx, compared to 19,652 (24.4 percent) among SZ veterans. DDx patients obtained more prescriptions than other patients over a similar period of time, and these effects were somewhat greater for BP DDx patients than for SZ DDx patients. DDx patients also showed more mental health services use and had more co‐morbidities. After controlling for these differences, DDx veterans still were dispensed more total psychotropic prescriptions, but most differences between diagnostic groups and medication class were no longer significant.
The paper shows that DDx veterans consume more resources in terms of both psychotropic medications and clinic visits. Further attention should be paid to the overall complexity of their clinical needs, including the increased likelihood of both licit and illicit drug‐drug interactions rather than just to their substance use.
Examines the construct validity of the Miner Sentence Completion Scale form‐H (MSCS‐H for hierarchic) as a measure of managerial role motivation theory in Hong Kong…
Examines the construct validity of the Miner Sentence Completion Scale form‐H (MSCS‐H for hierarchic) as a measure of managerial role motivation theory in Hong Kong. Managerial motivation or motivation to manage has been shown to be a major cause of managerial effectiveness and success in large bureaucratic organizations in the USA and elsewhere. Data were collected from a sample of Hong Kong business students. A three‐part questionnaire containing the MSCS‐H, demographic and educational background information, and objective measures relating to the MSCS‐H and its subscales was used as the research instrument. No significant influence of demographics and educational variables on levels of managerial motivation were detected. As hypothesized, the objective measures including the preference for managerial jobs and employment with a large company positively correlated with levels of motivation to manage. In addition, relevant questionnaire measures positively correlated with the underlying constructs of MSCS‐H. Overall, analyses provide further support for the construct validity of the theory’s main construct (MSCS‐H) in Hong Kong.