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Pharmaceutical Pricing and Reimbursement - Reference Pricing and Economic Evaluations Will Dominate Future Pricing and Reimbursement Strategies - Product Image

Pharmaceutical Pricing and Reimbursement - Reference Pricing and Economic Evaluations Will Dominate Future Pricing and Reimbursement Strategies

  • Published: February 2010
  • Region: Global
  • 83 Pages
  • GBI Research

“Pharmaceutical Pricing and Reimbursement - Reference Pricing and Economic Evaluations Will Dominate Future Pricing and Reimbursement Strategies” provides key data, information and analysis of the major issues affecting the pricing and reimbursement decisions across the globe. It discusses the major changes that have been observed in the pharmaceutical and healthcare industry at the global level. The report also covers issues specific to particular geographies. The geographies covered include the US and countries within Western Europe, Asia-Pacific, Central and Eastern Europe, and Scandinavia. It covers pricing and reimbursement mechanisms in different countries as well as the impact of issues on the key stakeholders. The report puts a special emphasis on orphan drugs since the pricing and reimbursement patterns for orphan drugs are different from the traditional mechanisms.

This report is built using data and information sourced from proprietary databases, primary and secondary research and in house analysis by a team of industry experts.

Scope

The scope of this report includes:

- Identification and analysis of major issues that are affecting READ MORE >

1 TOC
1.1 List of Tables
1.2 List of Figures

2 Introduction
2.1 Research Report Guidance

3 Pharmaceutical Pricing & Reimbursement Issues at Global Level – Innovative Mechanisms To Decrease the Healthcare Costs
3.1 Introduction
3.2 Issues at Global level
3.2.1 Value Based Pricing and Risk-Sharing Models
3.2.2 Increased Focus on Evidence-based Medicine and Health Technology Assessment (HTA)
3.2.3 Role of Pharmacoeconomics in Pricing and Reimbursement
3.3 Conclusion

4 Pricing and Reimbursement Issues in US – Government’s Cost Rationalization Efforts Will Make Future Tough for Big Pharma
4.1 New Nationwide Database to Set Healthcare Reimbursement Rates
4.2 Medicaid Pricing for Dual Eligibles of Medicare Part - D
4.3 New ICD-10 (International Classification of Diseases - 10) Coding System
4.4 Generic Price War at Retail Sector
4.5 MIPPA (Medicare Improvement for Patients and Providers Act), the AMP Rule Litigation
4.6 First DataBank/Medi-Span Settlement and the Impact on AWP
4.7 Conclusion

5 Pricing and Reimbursement Issues in Western Europe – Cost-Effectiveness is the Key to Success
5.1 Parallel Trade
5.2 EU Single Pricing - Still an Issue
5.3 International Price Referencing
5.4 Status quo of P&R in Western Europe
5.4.1 UK
5.4.2 France
5.4.3 Germany
5.4.4 Italy
5.4.5 Spain
5.5 Conclusion

6 Pricing and Reimbursement Issues in Central & Eastern Europe (CEE) and Scandinavia – Reference Pricing and Centralization Proves Detrimental for High Price Drugs
6.1 Central & Eastern Europe – Cost-Effectiveness is of Paramount Importance
6.1.1 Czech Republic
6.1.2 Poland
6.1.3 Austria
6.1.4 Romania
6.1.5 Hungary
6.2 Scandinavia – Moving Towards Centralized Healthcare Regime
6.2.1 Denmark
6.2.2 Norway
6.2.3 Sweden
6.2.4 Future Landscape
6.3 Conclusion

7 Pricing and Reimbursement Issues in Asia-Pacific – Negative Pricing Pressures Leaves Less Hope for Expensive Medicines
7.1 DPC (Diagnosis Procedure Combination) Reimbursement System in Japan - Immense Savings for the Government
7.2 Reforms in Chinese Pharmaceutical Market: Tougher Landscape for Generic and Off-Patent Brands
7.2.1 Active Ingredient Based Reimbursement: Restricted Market for Original Branded Products
7.2.2 New Regulatory Reforms: Stricter Rules for Innovation Seal
7.2.3 Price Cuts and Hospital Tendering Process: Erosion of Generic Margins
7.2.4 Future Scenario: Innovation is the Key for Western Pharmaceutical Companies
7.3 Transparency Issues with PBS in Australia
7.3.1 AUSFTA (Australia-United States Free Trade Agreement) - Boon for Branded Pharma
7.3.2 Access Issues for HCM (High Cost Medicines) and Controversial Selection Criteria
7.3.3 Consumer Participation in the PBS Drug Listing - A Move towards Greater Transparency and Cost-Efficiency
7.4 Conclusion

8 Pricing and Reimbursement Issues for Orphan Drugs – Excessive Prices of Orphan Drugs Increasing Financial Pressures on Government
8.1 Exploiting Orphan Drug Act; Maximizing Revenues
8.1.1 Ovation’s Indocin and Questcor’s H.P. Acthar Gel
8.2 Pricing of an Orphan Drug
8.3 Price Control Measures
8.3.1 Global Approach for Orphan Drug Development
8.3.2 Introducing Sales Ceiling and Flexible Market Exclusivity
8.3.3 Price Revisions
8.4 Conclusion

9 Key Takeaway

10 Appendix
10.1 Market Definitions
10.2 Key Support Data
10.3 Abbreviations
10.4 Research Methodology
10.4.1 Coverage
10.4.2 Secondary Research
10.4.3 Primary Research
10.4.4 Expert Panel Validation
10.5 Contact Us
10.6 Disclaimer
10.7 Sources

List of Tables:

Table 1: Examples of Pharmacoeconomic Evaluations in Ireland
Table 2: Drug Manufacturers Receiving Largest Windfalls, ($m), 2006–2007
Table 3: Pricing and Reimbursement Mechanisms in Western European countries
Table 4: Pricing and Reimbursement Mechanisms in Czech Republic, Romania, Austria, Poland and Hungary
Table 5: Different Pricing Mechanisms used in Czech Republic, Poland, Austria, Romania and Hungary
Table 6: Box Model for Reimbursement in Austria
Table 7: Comparative Analysis of Per Capita Healthcare Expenditures in the Scandinavian Countries, 2006
Table 8: Pricing and Reimbursement Mechanisms in the Scandinavian Countries
Table 9: Norway - Step Price System, 2008
Table 10: Trend in the Revision Rates of Reimbursement Prices in Japan, 1992–2008
Table 11: Sales in Pharmaceutical Industry, China, $bn, 1998–2008
Table 12: Increase in the Per Capita Expenditure for Medical Services in the Urban and Rural Households, China, $m, 1990–2006
Table 13: Ratio of Retail v/s Wholesale Price in Eight European Countries and China, 2005
Table 14: Definition and Incentives for Orphan Drugs in US, EU, Japan and Australia
Table 15: Average Annual Premiums for Family and Single Coverage. US, ($), 1999-2009
Table 16: Australia Drug Price Components and Payment Structure
Table 17: GDP (Nominal) Comparison Between Western Europe and Central & Eastern Europe, ($bn), 2008

List of Figures:

Figure 1: Comparison of Per Capita Expenditure on Health at Average Exchange Rate ($) v/s Life Expectancy, 2006
Figure 2: Comparison of CAGR of R&D Expenditure v/s Turnover Over the Last Five Years for the Top 5 Companies, 2003–2008
Figure 3: Value Based Pricing – Concept and Process
Figure 4: Impact Analysis: Value Based Pricing
Figure 5: Drivers and Restraints for EBM (Evidence Based Medicine)
Figure 6: Impact Analysis: Evidence Based Medicine
Figure 7: ISPOR 33 Guidelines for Pharmacoeconomics Assessment
Figure 8: Impact Analysis: Pharmacoeconomics
Figure 9: Average Annual Percentage Change in Manufacturer Prices for Most Widely Used Prescription Drugs in US
Figure 10: Case: An Example Of Data Tampering To Provide Artificially Low Reference Prices For Reimbursements Of Out-Of-Network Medical Expenses
Figure 11: Impact Analysis: New Database for Reimbursement Rates of Out-of-Network Medical Expenses
Figure 12: Comparison of Medicare Part D and Medicaid Discounts
Figure 13: Impact Analysis: Medicaid Pricing for Dual Eligibles in MPD (Medicare Part D)
Figure 14: ICD-10 Coding System; Features and Benefits
Figure 15: Impact Analysis: ICD-10 Coding System
Figure 16: Impact Analysis: Generic Price War
Figure 17: Impact Analysis: MIPPA (Medicare Improvement for Patients and Providers Act)
Figure 18: Impact Analysis: First DataBank/Medi-Span Settlement
Figure 19: Parallel Import Market Break-down, Europe, 2007, Total Size = $7.5bn
Figure 20: Impact Analysis: Parallel Trade
Figure 21: Price Level Indices for Pharmaceutical Products, EU25 = 100, 2005
Figure 22: Impact Analysis: EU Single Pricing
Figure 23: Impact Analysis: International Reference Pricing
Figure 24: Overshooting Actual Budget Expenditure, Hungary,(%), 1994–2005
Figure 25: Impact Analysis: P&R Issues in CEE and Scandinavia
Figure 26: Impact Analysis: DPC (Diagnosis Procedure Combination) Reimbursement System
Figure 27: Sales in Pharmaceutical Industry, China, $m, 1998–2008
Figure 28: Increase in the Per Capita Expenditure for Medical Services in the Urban and Rural Households, China, ($m), 1990–2006
Figure 29: Impact Analysis: Reforms in Chinese Pharmaceutical Market
Figure 30: Arguments For and Against the AUSFTA
Figure 31: Impact Analysis: AUSFTA
Figure 32: Number of Orphan Drugs Approved by FDA, 2000–2009
Figure 33: Factors Influencing the Pricing of an Orphan Drug
Figure 34: Correlation Between the Prevalence and the Annual Cost of Therapy for Orphan Drugs
Figure 35: Impact Analysis: Price Control Measures on Orphan Drugs
Figure 36: The US Healthcare Expenditure, Historical, $tn, 1980–2008
Figure 37: The US Healthcare Expenditure, Projections, ($tn), 2009–2018
Figure 38: GBI Research Methodology

Pharmaceutical Pricing and Reimbursement – Reference Pricing and Economic Evaluations Will Dominate Future Pricing and Reimbursement Strategies

Description

“Pharmaceutical Pricing and Reimbursement – Reference Pricing and Economic Evaluations Will Dominate Future Pricing and Reimbursement Strategies” provides key data, information and analysis of the major issues affecting the Pricing and Reimbursement decisions across the globe. It discusses the major changes that have been observed at the global level. The report also covers the issues specific to particular geographies as well. The geographies covered include the US and countries within Western Europe (the UK, France, Germany, Spain, Italy), Asia-Pacific (Japan, Australia, China), Central & Eastern Europe (Czech Republic, Poland, Austria, Hungary, Romania) and Scandinavia (Norway, Sweden, Denmark). It provides a comprehensive view of the best practices followed by the governments in these countries with respect to pricing and reimbursement of the prescription as well as generic drugs. The report also provides the impact analysis of each of the issue on the four key stakeholders concerned with the pricing and reimbursement practices that is pharmaceutical companies, payers, regulatory agencies and patients/doctors. The report puts a special emphasis on the orphan drugs since the pricing and reimbursement patterns for orphan drugs are different from the traditional mechanisms.

This report is built using data and information sourced from proprietary databases, primary and secondary research and in house analysis by a team of industry experts. Innovative Pricing and Reimbursement Mechanisms Due to Financial Pressures Will Continue to Exert Downward Pricing Pressures in Future

Major Pricing and Reimbursement Strategies Employed Across the Globe

Twin pressures of global economic meltdown and spiralling healthcare costs have forced several countries to adopt a conservative approach towards pricing and reimbursement of the cost of drugs. The rising cost of medicines, along with an unhealthy lifestyle of people in a number of countries, particularly developed countries, the burden on the healthcare systems to provide quality healthcare to each citizen is increasing. This increase directly impacts the governments’ ability to provide quality healthcare to its citizens, especially in countries where the healthcare system is largely government funded.

Different mechanisms, including reference pricing, cost-benefit analysis, health technology assessments and many others are being employed to bring down the price of prescription, as well as generic drugs. In addition, innovative pricing mechanisms, such as the Step Price System will continue to exert downward pricing pressure on pharmaceutical companies in the future.

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