Üretici miktar iskontoları varlığında eczacının ikame stratejisi ve Türkiye'de reçeteliden OTC' ye geçişin maliyet etkileri üzerine ampirik bir çalışma

This thesis consists of an empirical and a theoretical study focused on pharmaceutical industry.In Turkey, more than a hundred drugs have been removed from reimbursement since July 2006. Government?s recent reimbursement policy is interpreted as switching some drug categories from Rx (Prescription) to Over-the-Counter (OTC). In the first part of this thesis study, we analyze the effects of the change on consumption of both the switched drugs and their equivalent alternatives that are still reimbursed by the government. Our results suggest that there has been a significant decrease in the demand for the removed drugs, as expected. More importantly, in absolute terms, the increase in the equivalent drugs sales go beyond the decrease in removed drug sales for some of the ATC groups. Therefore, it is possible that the removal of these drugs from reimbursement may not produce the expected decrease in spending, and could even lead to an increase in total pharmaceutical expenditures. For the first time in the literature of Rx-to-OTC switches, we draw attention to the risk of increased cost to third-party payers due to the demand switch to reimbursed equivalent alternatives of the drugs that are made OTC available.In the second part of this study, we develop a mathematical model of the profit maximizing pharmacist who can substitute the requested drug with an alternative in the presence of manufacturer discounts. In pharmaceutical industry, it is common that pharmaceutical manufacturers provide attractive quantity discounts to the pharmacist in order to benefit from his substitution power. Our aim is to provide insights into pharmacist?s substitution strategy in the presence of manufacturer quantity discounts. The results of the study suggest that full substitution is optimal only when substitution is profitable for the pharmacist and the gain from quantity discount and substitution exceeds the holding cost. When the pharmacist incurs a positive substitution cost, no substitution is optimal if the discount benefit cannot compensate for the holding cost. Otherwise, the pharmacist engages in partial substitution by substituting all demand up to a point in the order cycle, beyond which holding costs make it unprofitable to substitute. To our knowledge, this study is the first to consider such a temporal partial substitution pattern. In addition, we show its optimality under specified conditions.