Pharmaceutical Market Access, Pricing, and Reimbursement News in the Third Quarter of 2009
Decision Resources, Inc, October 2009, Pages: 40
The third quarter of 2009 saw a heated debate in the United States over healthcare reform, the publication of a report on a European investigation of the pharmaceutical industry, the election of new governments in Japan and Germany, and new initiatives by governments in other countries to control their national pharmaceutical spending. Faced with declining revenues and increasing expenditures, healthcare payers in all markets are exerting increasing pressure on the pharmaceutical industry to cut costs and deliver genuine innovation.
Questions Answered in This Report:
In the United States, the Democrats are committed to passing healthcare reform legislation by the end of the year.
- What difficulties have lawmakers encountered in drafting legislation?
- What are the recent trends in health insurance coverage in the United States?
- What deal has the U.S. government struck with the pharmaceutical industry?
The French government is looking to cut $2 billion from the national healthcare budget in 2010.
- How much does the government hope to save by cutting prices, reducing the reimbursement rate of certain drugs, and stimulating greater use of generics?
- What impact are new voluntary physician contracts likely to have on the French pharmaceutical market?
Spending on prescription drugs by the German statutory health insurance system grew by 5.3% in 2008.
- How did spending and pricing trends compare for generic and branded drugs?
- What changes would some health insurance funds like the government to make to controls on pharmaceutical coverage?
- What new restriction has the government introduced on coverage for certain cancers?
The economic downturn is beginning to have an impact on the U.K. healthcare system.
- What is the effect on pharmaceutical budgets?
- How have recent price cuts and exchange rate movements altered parallel trade patterns and contributed to shortages of certain drugs?
The Japanese pricing and reimbursement environment faces the prospect of significant changes in the coming years.
- How is the new government likely to respond to industry proposals for a price maintenance system?
- How will generics feature in future government healthcare policy?
- What are the implications of a recently confirmed restriction on access to drugs not yet approved in Japan?
Scope
- Issues affecting the pharmaceutical industry in the United States: healthcare reform; health insurance trends; drug benefit trends; managed care executives’ views on comparative effectiveness research; regulatory pathway for biosimilars.
- Issues affecting the pharmaceutical industry in Europe: market trends; generic drug use; proposed prescribing and reimbursement restrictions; shifting patterns of parallel trade; impact of the economic downturn on the pharmaceutical market; access to medicines.
- Issues affecting the pharmaceutical industry in Japan: prospects for the introduction of a price maintenance system; government policy on generics; reimbursement of drugs not yet approved in Japan.
Executive Summary
- Strategic Considerations
- Stakeholder Implications
Overview
United States
- Healthcare Reform
- - An Increasingly Heated Debate
- - Slow Progress of Healthcare Reform Legislation
- - Government Deals with the Pharmaceutical Industry and Hospitals
- Health Insurance Trends
- - U.S. Census Bureau Survey
- - Centers for Disease Control and Prevention Survey
- - Kaiser Family Foundation/Health Research & Educational Trust Employer Survey
- - Kaiser Commission on Medicaid and the Uninsured Survey
- Drug Benefit Trends
- Comparative Effectiveness Research
- Regulatory Pathway for Biosimilars
European Union
- Publication of the Final Report of the Pharmaceutical Sectoral Inquiry
France
- New Cost-Containment Measures Proposed for 2010
- Continued Steady Growth in the Generics Market
Germany
- Market Trends
- Pressure for Reform from Health Insurance Funds
- Expansion of the Second Opinion Process
- New Government’s Deliberations on Healthcare Policy
Italy
- Creation of a New Working Group on Access to Medicines
- Italian Medicines Agency’s New Focus on Pharmaceutical Strategy and Economic Policy
Spain
- Double Legal Setback for the Pharmaceutical Industry
United Kingdom
- Economic Slowdown Exerts Pressure on Prescribing Budgets
- Supply Shortages Resulting from Parallel Exports
- Likely Delay to the Introduction of Generics Substitution
- Review of NICE’s Influence on Pharmaceutical Innovation
Japan
- Prospective Trial Introduction of a Price Maintenance System
- New Government Likely to Stimulate the Generics Market
- Barrier to Reimbursement of Drugs Not Yet Approved in Japan
Outlook and Implications for the Pharmaceutical Industry
Tables
1. Key Proposals for U.S. Healthcare Reform
Figures
1. Health Insurance Coverage of the Total U.S. Population, 1999-2008
2. Health Insurance Coverage of the Non elderly U.S. Population, 1999-2008
3. Health Insurance Coverage of the Senior U.S. Population, 1999-2008
4. Percentage of U.S. Employers Sponsoring Employee Health Benefits, 1999-2009
5. U.S. Employers That Sponsor Employee Health Benefits: Likelihood of Implementing Various Cost-Containment Measures in the Next Year
6. Percentage of U.S. Covered Workers in Formulary Designs of Various Structures, 2000-2009
7. Average Copayments in the United States by Formulary Tier, 2000-2009
8. Average Coinsurance Rates in the United States by Formulary Tier, 2000-2009
9. U.S. Employers’ Use of Common Utilization Management Tools, 2007-2009
10. U.S. Managed Care Executives’ Priorities for Comparative Effectiveness Research
11. Generics’ Share of the Japanese Pharmaceutical Market, Fiscal Years 2006-2008
- Agenzia Italiana del Farmaco (AIFA; Italian Medicines Agency)
- American Hospital Association
- Audiencia Nacional de España (National Court of Spain)
- Caisse Nationale d’Assurance Maladie (CNAM; National Health Insurance Fund)
- Catholic Health Association
- Center for Studying Health System Change (HSC)
- Centers for Disease Control and Prevention (CDC)
- Chuikyo (Central Social Insurance Medical Council)
- Congressional Budget Office (CBO)
- Federal Trade Commission (FTC)
- Federation of American Hospitals
- Federation of Pharmaceutical Manufacturers Associations of Japan (FPMAJ)
- Gemeinsamer Bundesausschuss der Ärzte, Zahnärzte, Krankenhäuser und Krankenkassen (GBA; Joint Federal Committee of Physicians, Dentists, Hospitals, and Health Insurance Funds)
- Haute Autorité de Santé (HAS; National Health Authority)
- Health Research & Educational Trust (HRET)
- Kaiser Commission on Medicaid and the Uninsured (KCMU)
- Kaiser Family Foundation (KFF)
- Pharmaceutical Research and Manufacturers of America (PhRMA)
- Pharmacy Benefit Management Institute (PBMI)
- Servicio de Inspección (Inspection Service)
- U.S. Census Bureau
- Wissenschaftliches Institut der Allgemeinen Ortskrankenkassen (WIdO; Scientific Institute of the General Local Insurance Funds)
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