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- August 2024
- Article
How Do Copayment Coupons Affect Branded Drug Prices and Quantities Purchased?
By: Leemore S. Dafny, Kate Ho and Edward Kong
Drug copayment coupons to reduce patient cost-sharing have become nearly ubiquitous for high-priced brand-name prescription drugs. Medicare bans such coupons on the grounds that they are kickbacks that induce utilization, but they are commonly used by... View Details
- June 2024
- Article
Valuing the Societal Impact of Medicines and Other Health Technologies: A User Guide to Current Best Practices
By: Jason Shafrin, Jaehong Kim, Joshua T. Cohen, Louis P. Garrison, Dana A. Goldman, Jalpa A. Doshi, Joshua Krieger, Darius N. Lakdawalla, Peter J. Neumann, Charles E. Phelps, Melanie D. Whittington and Richard Willke
This study argues that value assessment conducted from a societal perspective should rely on the Generalized Cost-Effectiveness Analysis (GCEA) framework proposed herein. Recently developed value assessment inventories—such as the Second Panel on Cost-Effectiveness’s... View Details
- March 2024
- Article
Medicare Price Negotiation and Pharmaceutical Innovation Following the Inflation Reduction Act
By: Matthew Vogel, Pragya Kakani, Amitabh Chandra and Rena M. Conti
The Inflation Reduction Act (IRA) requires Medicare to negotiate lower prices for some medicines with high Medicare spending. Using historical data from public and proprietary sources to apply the IRA's negotiation criteria retrospectively, we identify all drugs that... View Details
- January 2024
- Article
Cost of Exempting Sole Orphan Drugs from Medicare Negotiation
By: Matthew Vogel, Olivia Zhao, William B. Feldman, Amitabh Chandra, Aaron S. Kesselheim and Benjamin N. Rome
Importance: The Inflation Reduction Act (IRA) requires Medicare to negotiate prices for some high-spending drugs but exempts drugs approved solely for the treatment of a single rare disease.
Objective: To estimate Medicare spending and global... View Details
Objective: To estimate Medicare spending and global... View Details
- October 2023
- Article
What Does the Inflation Reduction Act Mean for Patients and Physicians?
By: Amitabh Chandra and Benedic Ippolito
The debate around prescription drug measures in the recently passed U.S. Inflation Reduction Act (IRA), which limit some patients’ out-of-pocket costs, has not fully addressed their effect on physicians and patients via their effect on payers. Reducing patients’ costs... View Details
- December 2022
- Article
The Contribution of Price Growth to Pharmaceutical Revenue Growth in the United States: Evidence from Medicines Sold in Retail Pharmacies
By: Pragya Kakani, Michael Chernew and Amitabh Chandra
Context: To what extent does pharmaceutical revenue growth depend on new medicines versus increasing prices for existing medicines? Moreover, does using list prices, as is commonly done, instead of prices net of confidential rebates offered by manufacturers, which are... View Details
- August 2022
- Article
Availability of New Medicines in the U.S. and Germany From 2004 to 2018
By: Katharina Blankart, Huseyin Naci and Amitabh Chandra
Importance: Germany's unique approach to coverage determination and pricing has ensured that effective medicines remain on the market, often at prices reduced through negotiation. However, less is known about trade-offs of this approach with regard to initial... View Details
- June 9, 2023
- Article
A Radical Treatment for Insulin Pricing
By: Leemore S. Dafny
In 2021, the Food and Drug Administration (FDA) approved the first interchangeable biosimilar for long-acting insulin, which many hoped would be substantially cheaper than the reference branded product. I explain why prices have barely changed, and argue that a... View Details
- 2021
- Working Paper
The Health Costs of Cost-Sharing
By: Amitabh Chandra, Evan Flack and Ziad Obermeyer
We use the design of Medicare’s prescription drug benefit program to demonstrate three facts about the health consequences of cost-sharing. First, we show that an as-if-random increase of 33.6% in out-of-pocket price (11.0 percentage points (p.p.) change in... View Details
- January 2021
- Case
Value-Based Insurance Design at Onex
By: Joshua Schwartzstein, Amitabh Chandra and Amram Migdal
The operating executives of Health and Benefits for Onex Partners, Megan Jackson Frye and Sam Camens, faced a challenge: Healthcare costs for employees of Onex’s portfolio companies were continuing to rise above the consumer price index, reflecting broader trends... View Details
Keywords: Decision Making; Cost vs Benefits; Decision Choices and Conditions; Decisions; Finance; Behavioral Finance; Insurance; Health; Health Care and Treatment; Human Resources; Compensation and Benefits; Markets; Demand and Consumers; Consumer Behavior; Social Psychology; Behavior; Interests; Motivation and Incentives; Perception; Health Industry; Insurance Industry; North America; United States
- January 2021 (Revised June 2021)
- Case
Hester Pharmaceuticals (A): A Pricing Dilemma
By: Dante Roscini and John Masko
In August 2019, the leadership of Hester Pharmaceuticals (Hester) had a problem. Italy promised to be a key market for their new breakthrough oncology drug Akrozumab, but for almost two years, its single-payer healthcare system had been unable to agree with Hester on a... View Details
Keywords: Macroeconomics; Trade; Price; Global Range; Global Strategy; Globalized Markets and Industries; Health Care and Treatment; Patents; Monopoly; Negotiation; Business and Government Relations; Risk and Uncertainty; Human Needs; Business Strategy; Commercialization; Pharmaceutical Industry; Italy
- Working Paper
Rebates in the Pharmaceutical Industry: Evidence from Medicines Sold in Retail Pharmacies in the U.S.
By: Pragya Kakani, Michael Chernew and Amitabh Chandra
Rising list prices are often used to illustrate the burden of prescription drug spending, but payers routinely negotiate rebates from manufacturers that generate differences between list and net prices. List prices are easily available and affect patient cost-sharing,... View Details
- 2018
- Chapter
The Orphan Drug Act at 35: Observations and an Outlook for the Twenty-First Century
By: Nicholas Bagley, Benjamin Berger, Amitabh Chandra, Craig Garthwaite and Ariel Dora Stern
On the 35th anniversary of the adoption of the Orphan Drug Act (ODA), we describe the enormous changes in the markets for therapies for rare diseases that have emerged over recent decades. The most prominent example is the fact that the profit-maximizing price of new... View Details
- April 2017
- Supplement
Imprimis (C)
By: Ramon Casadesus-Masanell, Karen Elterman and Marc Appel
This case is a supplement to Imprimis (A & B). Set in 2015, it first describes Imprimis’s decision to introduce its own line of compounded eye drop medication called LessDrops. The case then examines the moral dilemma faced by CEO Mark Baum, who was struck by the... View Details
- April 2017
- Supplement
Imprimis (D)
By: Ramon Casadesus-Masanell, Karen Elterman and Marc Appel
This case is a supplement to Imprimis (A, B, & C). It describes Imprimis’s 2015 decision to develop a $1 per pill compounded alternative to Daraprim, the branded drug that had recently undergone an extreme price hike, raising its price to $750 per pill. Imprimis also... View Details
- Article
Undermining Value-Based Purchasing — Lessons from the Pharmaceutical Industry
By: Leemore S. Dafny, Christopher Ody and Matt Schmitt
The analogy between value-based purchasing in pharmaceuticals and the new frontier of alternative payment models for health care providers is relatively straightforward. Insurers are increasingly demanding steep discounts from providers in exchange for inclusion in... View Details
- March 2015 (Revised January 2024)
- Case
CV Ingenuity (A): How to Evaluate the Commercial Viability of New Health Care Technologies
By: Regina E. Herzlinger and Andrew Otazo
Duke Rohlen (HBS MBA ’01) hoped to win over a prominent venture capital investor for Series B financing of his firm CVI that was creating a drug-eluting balloon (DES) to treat peripheral arterial disease. As a second-mover, Duke felt he was more likely to acquire... View Details
Keywords: CV Ingenuity; CVI; Drug Eluting Balloon; DEB; Drug Eluting Stent; Angioplasty Balloon; FoxHollow; Medical Device; Medical Device Startup; Premarket Approval; PMA; Lutonix; Stellarex; LEVANT; ILLUMENATE; Clinical Trials; Peripheral Arterial Disease; PAD; Healthcare Startups; Covidien; Health Care and Treatment; Health Testing and Trials; Business Startups; Commercialization; Health Industry; Medical Devices and Supplies Industry; United States; Europe
- October 2014 (Revised April 2023)
- Case
Gilead: Hepatitis C Access Strategy (A)
By: V. Kasturi Rangan, Vikram Rangan and David E. Bloom
Gilead had come up with an innovative drug for Hepatitis C, which affected 180 million people worldwide. The drug was priced at $1,000 a pill for the US market. Gilead had to decide how to price and market the pill in developing countries that bore the brunt of the... View Details
- September 2014 (Revised February 2015)
- Case
Pfizer and AstraZeneca: Marketing an Acquisition (A)
By: John A. Quelch and James Weber
In 2014, Pfizer proposed a friendly acquisition of AstraZeneca, but the AstraZeneca board resisted over price and strategy concerns. Was this good for pharmaceutical consumers? Pfizer, like pharmaceutical companies in general, faced difficulties in growing sales due to... View Details
- August 2012 (Revised August 2024)
- Case
ABC Pharmaceuticals
By: Regina E. Herzlinger and Erik R. Sparks
This case asks students to price a new drug that is in Stage II of its clinical trials. It contains detailed estimates of the time required and costs for all the steps needed to commercialize a drug in the U.S. Students will learn virtually all the steps required to... View Details