A Need for Government Intervention? Prescription Drug Prices and Retail Mark-Ups

Susan L. Pearson, the degree of Master of Arts in Political Science, 4
February 2011
Blacksburg, Virginia

출처 : http://scholar.lib.vt.edu/theses/available/etd-02182011-012738/unrestricted/Pearson_SL_T_2011Revised.pdf

Table of Contents
Abstract…………………………………………………………………………………….ii
Dedication…………………………………………………………………………………iii
Acknowledgments…………………………………………………………………………iv
Table of Contents…………………………………………………………………………..v
Tables………………………………………………………………………………………vii
Figures…………………………………………………………………………………….viii
Chapter 1 Introduction………………………………………………………………………1
1.1 Price data.…………………………………………………………………..……2
1.2 Significance..……………………………………………………………………4
1.3 Limitations……..…………….………………………………………………….5
1.4 Overview of study……………………………………………………………….7
Chapter 2 Relevant Scholarship.……………………………………………………………8
2.1 History of Congressional examinations of prescription drug prices……………8
2.2 State intervention..……………………………………………………………..14
2.3 Private examinations of pharmaceutical prices..……………………………….17
2.4 Economics of pricing..…………………………………………………………26
2.5 Conclusions..……………………………………………………………………30
Chapter 3 Research Design…………………………………………………………………32
3.1 Selection of drug manufacturers and prescription medications..……………….32
3.2 Non-prescription drugs…………………………………………………………..36
3.3 Selection of regions and pharmacy categories..…………………………………38
3.4 First round of questionnaires and responses..…………………………………..40
3.5 Second round of questionnaires and responses..………………………………..41
3.6 Conclusions..……………………………………………………………………43
Chapter 4 Findings…………………………………………………………………….……44
4.1 Responses.………………………………………………………………………44
4.2 Overview of the data..…………………………………………………………..45
4.3 Data by pharmacy type..…………………………………………………………49
4.4 Data by drug..……………………………………………………………………50
4.5 The control drugs..………………………………………………………………53
4.6 Conclusions..…………………………………………………………………….54
Chapter 5 Conclusions………………………………………………………………………56
5.1 Negotiating wholesale prices..…………………………………………………..56
5.2 Standard markups?…………………………………………………………………………………..57
5.3 The pharmacists’ responses..……………………………………………………59
5.4 Life-saving vs. life-enhancing drugs..…………………………………………..60
5.5 Future Research..………………………………………………………………..61
5.6 Concluding statements..…………………………………………………………64
References………………………………………………………………..…………….……66
Appendix A: IRB Materials…………………………………………………………………73
A.1 Initial approval marking this study as exempt………………………………….74
A.2 Second amendment for addition of new Large National Discount Retailer
Pharmacy…………………………………………………………………………….75
A.3 Final amendment for the addition of telephone questionnaires………………….76
Appendix B: Supporting Study Documents…………………………………………………77
B.1 Consent form……………………………………………………………………77
B.2 Questionnaire…………………………………………………………………….80
B.3 Telephone questionnaire…………………………………………………………82
B.4 Follow-up letter………………………………………………………………….83
B.5 Verbal consent speech for telephone interviews…………………………………85

Tables
Table 4.1 Price per-pill by pharmacy and drug…………………………………45
Table 4.2 Markup per-pill by type of pharmacy and drug…………………………46
Table 4.3 Percentage markup per-pill by type of pharmacy and drug……………..47
Table 4.4 Prices per-30 pill supply by type of pharmacy and wholesale
price and drug…47
Table 4.5 Price markups per 30 pill supply by type of pharmacy and drug……..48
Table 4.6 Percent markups per 30 pill supply by type of pharmacy and drug…..48
Table 4.7 Percent markup per pill by responding independent pharmacy and drug.50
Table 4.8 Percent markup per pill by responding large chain pharmacy and drug…50
Table 4.9 Percent markup per pill by responding large national
discount retailer pharmacy and drug…………………………………………51

Figures
Figure 3.1 Pharmacy Market Structure…………………………………………………..3
Figure 4.1 Average mark-up by pharmacy type………………………………….51
Figure 4.2 Lowest mark-ups by prescription drug………………………………….52
Figure 4.3 Highest mark-ups by prescription drug………………………………….52
Figure 4.5 Mean mark-ups by prescription drug……………………………………53