Pharmaceuticals are priced uniformly by convention, but vary in their degree of effectiveness for different disease indications. As more high-cost therapies have launched, the demand for alternative payment models (APMs) has been increasing in many advanced markets, despite their well-documented limitations and challenges to implementation. Among policy justifications for such contracts is the maximization of value given scarce resources. We show that while uniform pricing rules can handle variable effectiveness in efficient markets, market inefficiencies of other kinds create a role for different value-based pricing structures. We first present a stylized theoretical model of efficient interaction among drug manufacturers, payers, and beneficiaries. In this stylized setting, uniform pricing works well, even when treatment effects are variable. We then use this framework to define market failures that result in obstacles to uniform pricing. The market failures we identify include: (1) uncertainty of patient distribution, (2) asymmetric beliefs, (3) agency imperfection by payer, (4) agency imperfection by provider, and (5) patient behavior and treatment adherence. We then apply our insights to real-world examples of alternative payment models, and highlight challenges related to contract implementation.

按照惯例，药品的定价是统一的，但其针对不同疾病适应症的有效性程度有所不同。随着更多高成本疗法的推出，许多先进市场对替代支付模式 (APM) 的需求不断增加，尽管其局限性和实施挑战已得到充分证明。此类合同的政策理由之一是在稀缺资源的情况下实现价值最大化。我们表明，虽然统一的定价规则可以处理有效市场中的可变有效性，但其他类型的市场低效率为不同的基于价值的定价结构创造了作用。我们首先提出了药品制造商、付款人和受益人之间有效互动的程式化理论模型。在这种程式化的环境中，即使治疗效果存在差异，统一定价也能发挥良好作用。然后，我们使用这个框架来定义导致统一定价障碍的市场失灵。我们发现的市场失灵包括：（1）患者分布的不确定性，（2）信念不对称，（3）付款人的代理不完善，（4）提供者的代理不完善，以及（5）患者行为和治疗依从性。然后，我们将我们的见解应用于替代支付模式的现实示例，并强调与合同实施相关的挑战。