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The Pricing and Reimbursement Environment for Respiratory Disease Therapies
Decision Resources, Inc, Oct 2011
Common respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) make up a large and varied pharmaceutical market sector. These diseases also impose a significant burden on patients, providers, and payers, putting them front and center as the subjects of efforts to improve patient outcomes while containing costs to health systems. Governments and other payers are compelled to invest substantial resources in the management of these disorders. At the same time, payers continue to scrutinize the cost-to-benefit ratio of all therapeutic options very closely. The pharmaceutical industry will need to make a clear case for the role of drug therapy as a critical component in the effective management of respiratory disorders.
Questions answered in this report:
- In the United States, Medicare prescription drug plans generally offer less-favorable coverage of respiratory drugs than commercial health plans. How do Medicare and commercial plans differ in their coverage? Which drugs have the most and least favorable coverage? Which cost-containment measures are most frequently applied to respiratory drugs in the United States?
- A recent survey of U.S. physicians found widespread concern about their patients’ ability to afford respiratory disease therapies. How great is the burden on patients, and how does it affect their behavior? For which disease do physicians have the greatest concern about the affordability of prescription drugs? What new cost-containment measures do U.S. physicians expect health plans to implement in the next five years?
- In France, asthma and COPD are classified as affections de longue durée (ALDs; chronic disorders). What are the implications of this status for patients who are diagnosed with these disorders? How does ALD status influence physicians’ prescribing behavior?
- German physicians are generally more comfortable with prescribing inhaled generics than clinicians in most other countries. How common is the use of generic inhaled respiratory drugs in Germany? What cost-containment pressures account for the widespread use of generics in Germany?
- The chief executive of Asthma UK recently stated that asthma management costs the country more than £1 billion ($1.5 billion) annually. Which drugs are the main contributors to this bill? What action are primary care trusts (PCTs) taking to try to curb spending? What initiatives are the government and the National Institute for Health and Clinical Excellence (NICE) pursuing to try to improve the management of respiratory disorders in the United Kingdom?
Scope:
Markets covered: United States, France, Germany, Italy, Spain, United Kingdom, Japan.
Healthcare system overviews: Healthcare sector reforms; roles of public and private payers; formulary decision makers.
Epidemiology: Prevalence of key respiratory diseases and drug-treatment rates in the seven major pharmaceutical markets in 2010 and 2020.
Pharmaceutical pricing: Procedures for setting prices; use of external reference pricing.
Admission to reimbursement: Bodies involved in reimbursement decision making; reimbursement procedures; reimbursement rates.
Cost containment: Reference pricing; prescribing restrictions; measures to promote greater use of generics.
Primary research: Results from a Web-based survey of 105 U.S. pulmonologists and primary care physicians (PCPs) who manage patients with respiratory diseases.
Outlook: Future pricing and reimbursement landscape for respiratory drug therapies.
Exhibits: 33 tables and figures showing comparative drug prices, respiratory disease epidemiology, market data, healthcare system characteristics, U.S. physician survey data, and payer coverage.
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