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February 25, 20260 citationsOpen Access

The Prescription Cascade: Void Architecture in US Pharmaceutical Markets

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AEAnthony W. Eckert

Key Points

  • The aim is to explore pharmaceutical market structures using a thermodynamic void framework to identify key pricing factors.
  • Applied thermodynamic void framework to analyze 33 drug categories
  • Scored categories on opacity, responsiveness, and coupling
  • Conducted international comparisons on insulin glargine
  • Used Spearman correlations to assess relationships between variables
  • Formulated seven falsifiable predictions for future testing
  • High correlation between opacity and market concentration (Spearman V=0.839)
  • Significant differences in price elasticity (Pe) across countries for the same drug
  • Daraprim's market concentration significantly impacts its price elasticity compared to OxyContin
  • Pharmaceutical benefits managers identified as amplifiers of systemic pricing issues
  • Predictions allow for testing and validation using CMS, FDA, and IQVIA data from 2025-2027

Abstract

Applies thermodynamic void framework to pharmaceutical market structure. N=33 drug categories scored on Opacity, Responsiveness, and Coupling. Spearman(V, HHI)=0.839, p<0.000001, LOO 0.823, 0.873. International comparison: same drug (insulin glargine), same physiological coupling (α=3), radically different Pe based on regulatory architecture (US Pe=+43.9, Canada Pe=−4.2, Germany Pe=−25.9). Discriminant validity: Daraprim (highest HHI=10,000) Pe=12.9 vs OxyContin (α=3 coupling) Pe=43.9, 3.4× difference confirming α as harm multiplier over market concentration. Identifies PBM rebate layer as hidden systemic amplifier (Pe=25.2). Seven falsifiable predictions testable from public CMS, FDA, and IQVIA data 2025-2027.

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Cite This Study

Anthony W. Eckert (2026) studied this question.

synapsesocial.com/papers/699e921bf5123be5ed0501bbhttps://doi.org/10.5281/zenodo.18740039
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