Evaluation of a Partial Ban on Rx-Rebates in Germany

We investigate patients' price sensitivity for prescription (Rx) drugs with regards to patronizing online or brick-and-mortar pharmacies. In doing so, we exploit a policy change in Germany that prohibited online pharmacies from granting rebates to one part of the population, the members of the statutory health insurance scheme. This policy change created a natural experiment, allowing us to analyze its impact on the pharmaceutical market using Difference-in-Differences (DiD). Utilizing a novel dataset obtained from merchandize information systems, we find that the ban led to a shift in consumer behavior, increasing offline pharmacy Rx sales by 1.42%-1.67%. In a second step, we assess to what extent the policy change achieved its alleged goal of supporting brick-and-mortar pharmacies. Our findings indicate that pharmacies with low revenues, which are most exposed to market exit, saw only a minor increase in annual revenues of around € 1587. At the same time, pharmacies in the highest decile gained roughly four times that amount. This indicates that the policy change alone was insufficient to reverse the declining trend in pharmacy numbers in Germany. To strengthen the comprehensive supply of pharmaceuticals to the general population, additional reforms seem necessary.