Pricing Intermediaries in Prescription Drug Markets: To Leverage or Replace?

I address the debate over whether Pharmacy Benefit Managers (PBMs) are effective at controlling prescription drug prices. First, I collect data on the average negotiated prices of anti-cholesterol drugs in order to better measure outcomes under PBM involvement. Second, I embed PBM formulary design and price negotiation in a dynamic oligopoly model of drug pricing, and estimate the model using the negotiated price data. Compared to outcomes under a pricing structure without negotiation, PBMs reduce overall spending by 15%. This is the net result of a 25% decrease in drug company revenues and PBMs capturing part of the savings. PBMs achieve this by leveraging credible threats of restrictive formularies, without actually having to greatly limit patient access in equilibrium. My results speak to competing Medicare drug policy proposals that aim to either leverage or replace PBMs.