Journal of Business Ethics

, Volume 84, Supplement 1, pp 75–88 | Cite as

Where Strategy and Ethics Converge: Pharmaceutical Industry Pricing Policy for Medicare Part D Beneficiaries

  • Edward R. BalotskyEmail author


On January 1, 2006, Medicare Part D prescription drug coverage was initiated. Concern was immediately voiced by the American Association of Retired Persons (AARP) and Families USA that, in response to this program, the pharmaceutical industry may raise prices for drugs most often used by the elderly. This article examines the ethical implications of a revenue-maximizing pricing strategy in an industry in which third party financing mitigates an end product’s true cost to the user. The perspectives of three stakeholder groups are examined: the elderly, as consumers of prescription drugs, the pharmaceutical industry, as product manufacturer and beneficiary of derived profits, and the total U.S. population, as the ultimate payer for the program via tax revenues. Key questions explored include the relationships among price strategy and access to drugs at both the micro (Medicare cohort) and macro (total population) levels, and on drug development or enhancement. The role of profit in a capitalism-based health care system is also examined. Hospital industry impact on these same stakeholder groups in response to the original 1965 Medicare law is used to compare and contrast possible outcomes of the new drug program. It is predicted that pharmaceutical firms will mimic the hospital industry, adopting a price maximizing strategy for drugs covered by the program. In the process, a utilitarian effect occurs: the benefits of increased access and diffusion of drugs counterbalance inequities in financing Medicare Part D.


access diffusion ethics pricing strategy 


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  1. Abboud, L.: 2004, ‹Abbott’s Pricing on AIDS Drug Prompts Call for an Early Generic’, Wall Street Journal, May 13, D.7Google Scholar
  2. Adams C., V. Brantner 2006, Estimating the Cost of New Drug Development: Is It Really Worth $802 Million? Health Affairs, 25(2), 420–428CrossRefGoogle Scholar
  3. Anderson O. 1985, Health Services in the United States: A Growth Enterprise Since 1875. Ann Arbor: Health Administration PressGoogle Scholar
  4. Anonymous: 2005, ‹Medicare’, Social Security Bulletin, 35–50Google Scholar
  5. Balotsky E. R. 2005, Is It Resources, Habit or Both: Interpreting Twenty Years of Hospital Strategic Response to Prospective Payment. Health Care Management Review, 30(4), 337–346Google Scholar
  6. Biles B., G. Dallek, L. Nicholas 2004, Medicare Advantage: Déjà Vu All Over Again? Health Affairs, 23, 586–597Google Scholar
  7. Binder, C., L. Gross, D. Gross, S. Schondelmeyer and S.␣Raetzman: 2006, ‹Trends in Manufacturer Prices of Prescription Drugs Used by Older Americans’, Available at
  8. Bishop C., L. Dubay 1991, Medicare Patient Access to Posthospital Skilled Nursing Facility Care. Inquiry – Blue Cross and Blue Shield Association, 28(4), 345–356Google Scholar
  9. Callahan D. 2006, Curing, Caring and Coping. America, 194(3), 12–16Google Scholar
  10. Cohen E. 2004, The Politics and Realities of Medicare. Public Interest, 156, 37–50Google Scholar
  11. DeFrances C., M. Podgornik 2006, 2004 National Hospital Discharge Survey. Advance Data from Vital and Health Statistics, 371, 1–20Google Scholar
  12. DeParle N. 2002: As Good as It Gets? The Future of Medicare+ Choice. Journal of Health Politics, Policy and Law, 27(3), 495–513CrossRefGoogle Scholar
  13. Dor A. 1989, The Cost of Medicare Patients in Nursing Homes in the United States: A Multiple Output Analysis. Journal of Health Economics, 8(3), 253–270CrossRefGoogle Scholar
  14. Druss B., S. Marcus, M. Olfson, H. Pincus 2004, Listening to Generic Prozac: Winners, Losers, and Sideliners. Health Affairs, 23(5), 210–216CrossRefGoogle Scholar
  15. Frank R. 2001, Prescription Drug Prices: Why do Some Pay More than Others do? Health Affairs, 20(2), 115–128CrossRefGoogle Scholar
  16. Freudenheim, M.: 2006, ‹A Windfall from Shifts to Medicare’, New York Times, Available at
  17. Friedman, M.: 1970, ‹The Social Responsibility of Business is to Increase Profits’, The New York Times Magazine, September 13Google Scholar
  18. Gasorek D. 2005, Pharma Ethics: Who Sees the Halo? Pharmaceutical Executive, 25(6), 68–72Google Scholar
  19. Gebhart F. 2004, How do Manufacturers Set Drug Prices? Here’s a Look. Drug Topics, 148, 64Google Scholar
  20. Gold M. 2005, Private Plans in Medicare: Another Look. Health Affairs, 24(5), 1302–1310CrossRefGoogle Scholar
  21. Gottlieb S. 2005, Treating and Curing Diseases. Vital Speeches of the Day, 72(5), 147–151Google Scholar
  22. Gresham, L.: 2006, ‹Riding the Generics Wave to Drug Savings’, Employee Benefit News, June 15, 1Google Scholar
  23. Hansen C. 2004, Who are the Drug Companies Hurting. Vital Speeches of the Day, 70(10), 301–305Google Scholar
  24. Heavey, S.: 2006, ‹U.S. Says Medicare Drug Plan Passes 30 Million Goal’, Available at, April 24, 2006
  25. Heffler, S., S. Smith, S. Keehan, K. Clemens, C. Truffer and M. Zezza: 2004, ‹Health Spending Projections Through 2013’, Health Affairs, Web Exclusives, W79–W92Google Scholar
  26. Hislop R. 2001, The Politics of Medicare and Prescription Drug Costs. Human Rights, 28(2), 15–16Google Scholar
  27. Laschober, M., M. Kitchman, P. Neuman and A. Strabic: 2003, ‹Trends in Medicare Supplemental Insurance and Prescription Drug Coverage’, Health Affairs, Web Exclusives, W127Google Scholar
  28. Levya-Gardner K. 2006, Drug Plans: Balance Quality, Affordability. Credit Union Magazine, 72(7), 48Google Scholar
  29. Mahan, D.: 2006, ‹Big Dollars, Little Sense: Rising Medicare Prescription Drug Prices’, Available at
  30. Maitland I. 2002, Priceless Goods: How Should Life-Saving Drugs be Priced? Business Ethics Quarterly, 12(4), 451–480CrossRefGoogle Scholar
  31. Malloy J., D. Skinner 1984, Medicare on the Critical List. Harvard Business Review, 62(6), 122–135Google Scholar
  32. Mokhiber R., R. Weissman 2003, Multiple Corporate Personality Disorder: The 10 Worst Corporations of 2003. Multinational Monitor, 24(12), 9–20Google Scholar
  33. Mole R. 2005, Big ‹Bad’ Pharma. Journal of Medical Marketing, 5(3), 261–263CrossRefGoogle Scholar
  34. National Health Care Expenditures: 1960–2004, Available at
  35. National Health Care Expenditures Projections: 2005–2015, Available at
  36. Newhouse J. 2004, How Much Should Medicare Pay for Drugs. Health Affairs, 23(1), 89–101CrossRefGoogle Scholar
  37. Nichols L. M., P. B. Ginsburg, R. A. Berenson, J. Christianson, R. E. Hurley 2004, Are Market Forces Strong Enough to Deliver Efficient Health Care Systems, Confidence is Waning. Health Affairs, 23(2), 8–21CrossRefGoogle Scholar
  38. Okunade A. 2006. Medicare Reform: Successes and Current Challenges of the New Part D Program. Business Perspectives, 18(1), 32–37Google Scholar
  39. Porth S., G. Sillup 2005, Good News Bad News. Pharmaceutical Executive, 25(4), 106–110Google Scholar
  40. Safran D., P. Neuman, C. Schoen, M. Kitchman, B. Cooper, I. Wilson, A. Li, H. Chang, W. Rogers 2005, Prescription Drug Coverage and Seniors: Findings from a 2003 National Survey. Health Affairs, 24, 152–166Google Scholar
  41. Santangelo M. 2006, Historical Perspective on Adding Drugs to Medicare. Health Care Financing Review, 27(2), 25–33Google Scholar
  42. Santerre R., J. Vernon, C. Giaccotto 2006, The Impact of Indirect Government Controls on U.S. Drug Prices and R&D. Cato Journal, 26(1), 143–165Google Scholar
  43. Scanlon W. 2006, The Future of Medicare Hospital Payment. Health Affairs, 25(1), 70–80CrossRefGoogle Scholar
  44. Sear A. 2004, Effects of Medicare BBA Spending Reductions on the Profitability of General Acute Care Hospitals. Journal of Healthcare Management, 49(2), 119–133Google Scholar
  45. Sharfstein S. S., L. M. Koran 1990, Mental Health Services. In A. R. Kovner (Ed.), Health Care Delivery in the United States (4th ed.), New York: Springer, 209–239Google Scholar
  46. Silvers J. 2001, The Role of Capital Markets in Restructuring Health Care. Journal of Health Politics, Policy and Law, 26(5), 1019–1030CrossRefGoogle Scholar
  47. Spinello R. 1992, Ethics, Pricing and the Pharmaceutical Industry. Journal of Business Ethics, 11(8), 617–626CrossRefGoogle Scholar
  48. Starr P. 1982, The Social Transformation of American Medicine. New York: BasicGoogle Scholar
  49. Straube B. 2005, How Changes in the Medicare Coverage Process have Facilitated the Spread of New Technologies. Health Affairs, 24, 314–316Google Scholar
  50. Studdert D., M. Mello, T. Brennan 2004, Financial Conflicts of Interest in Physicians’ Relationships with the Pharmaceutical Industry: Self-Regulation in the Shadow of Federal Prosecution. The New England Journal of Medicine, 351(18), 1891–1900CrossRefGoogle Scholar
  51. Szabo, L.: 2006, ‹Prices Soar for Cancer Drugs’, USA Today, Available at
  52. Towse A. 2003, The Efficient Use of Pharmaceuticals: Does Europe have Any Lessons for a Medicare Drug Benefit? Health Affairs, 22(3), 42–50CrossRefGoogle Scholar
  53. Verschoor C. 2006, Pharma Industry has Many Ethical Issues. Strategic Finance, 87(8), 16–18Google Scholar
  54. Vladeck B. 2004, The Struggle for the Soul of Medicare. The Journal of Law, Medicine & Ethics, 32(3), 410–415CrossRefGoogle Scholar
  55. White J., S. Taft 2004, Frameworks for Teaching and Learning Business Ethics Within the Global Context: Background of Ethical Theories. Journal of Management Education, 28(4), 463–477CrossRefGoogle Scholar
  56. Wiggins S., R. Maness 2004, Price Competition in Pharmaceutical: The Case of Anti-Infectives. Economic Inquiry, 42(2), 247–263CrossRefGoogle Scholar
  57. Wing K. R. 1985, The Law and the Public’s Health (2nd ed.). Ann Arbor: Health Administration PressGoogle Scholar
  58. Worzala C., J. Pettengill, J. Ashby 2003, Challenges and Opportunities for Medicare’s Original Prospective Payment. Health Affairs, 22(6), 175–182CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  1. 1.Haub School of BusinessSaint Joseph’s UniversityPhiladelphiaU.S.A.

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