LAUSR

Abstract Between 1960 and 2016 per capita expenditures on retail pharmaceuticals increased from $85.12 to $922.50 in 2009 prices, while the share of spending covered by insurance programs grew to 86%. The introduction of new molecular entities followed only a weak upward trend. Following passage of the Hatch Waxman Act in 1984, the share of retail prescriptions dispensed as generics has expanded from 19% to almost 90%. By employing a three-equation Vector Auto-Regressive (VAR) model and Granger causality, this paper assesses empirically the interdependence among these variables. Our most important finding is that increases in insurance coverage on pharmaceuticals contributed significantly to the spending growth, which in turn led to further insurance expansion. In addition, introduction of new drugs also has contributed to enhanced insurance coverage. While the expansion of generic prescribing has had a strong negative effect on spending, this effect has been largely offset by rapid increases in coverage.