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Market Access in the United States: An Uncertain Outlook
Decision Resources, Inc, Nov 2011
The outlook for the U.S. pharmaceutical market is more uncertain than at any other time in recent years. The number of uninsured residents and Medicaid beneficiaries has grown steadily, while the percentage of the nonelderly population covered by employer-sponsored insurance has declined significantly. The quality of benefits is under pressure as payers increase cost sharing and implement policies to restrict the use of high-priced drugs. Healthcare reform promises to boost access to health benefits, but the future for this legislation remains very uncertain.
Questions Answered:
- According to the Census Bureau, the number of uninsured U.S. residents increased by 32% from 1999 to 2010. How many people lacked health insurance in 2010? How many have been uninsured for more than 12 months? How extensive is the problem of underinsurance in the United States?
- The percentage of U.S. employers that offer health benefits declined from a peak of 68% in 2001 to 59% in 2011. How has the percentage of the nonelderly population covered by employer-sponsored health insurance changed in recent years? What strategies are employers pursuing to contain the cost of providing health benefits? What changes are companies making to benefit designs?
- Medicare is the dominant form of health insurance among senior citizens. Which other forms of coverage do the elderly have? How do Medicare and commercial health plans compare in their use of multitier formularies, copayments, and coinsurance? What utilization management tools are most commonly used by Medicare plans? What new payment models are under trial?
- Medicaid—the joint federal and state government-sponsored health insurance program for low-income residents—is the fastest growing form of health insurance. What percentage of the U.S. population relies on Medicaid for health benefits? Why are state Medicaid programs under increasing pressure? How are state administrations trying to control their Medicaid expenditures? What plans are there to expand the Medicaid population in coming years?
- The Patient Protection and Affordable Care Act (PPACA) promises to effect the most radical transformation of the U.S. healthcare system since the creation of the Medicare and Medicaid programs in 1965. What are the key reforms in this legislation, and when are they scheduled to take effect? What impact has the legislation had on the U.S. healthcare system to date? What opposition has healthcare reform encountered?
- The U.S. pharmaceutical market’s annual growth rate declined from 15% in 2001 to just 2.3% in 2010. How do recent growth rates compare for branded drugs versus generics, and small-molecule drugs versus biologics? How has the uptake of new drugs changed in recent years? What has happened to the rate of generic erosion?
- The outlook for the U.S. pharmaceutical market is more uncertain than at any other time in recent years. What impact might increasing budgetary pressures have on the healthcare system? What are the implications of the Supreme Court’s recent decision to hear appeals against the PPACA? How are cost-containment pressures likely to intensify in coming years?
Scope:
- Access to health insurance: variations in health insurance coverage by demographic group; changing patterns of employer-sponsored health insurance; disturbing growth in the ranks of the uninsured; increase in the number of Medicaid beneficiaries.
- Continued criticism of U.S. pharmaceutical prices: drug price inflation; rebate trends.
- Pharmaceutical market trends: market size and growth rates; declining uptake of new drugs; accelerating rate of generic erosion; shifts in patterns of funding for prescription drugs; pharmacy benefit management companies’ reported growth rates for pharmaceutical expenditures.
- Employer-sponsored health plans: growth of multitier formularies; patient copayments and coinsurance; utilization management tools; clinical and educational programs; strategies to promote greater use of generics; value-based benefit designs; management of specialty pharmacy costs.
- Medicare: growth of multitier formularies; patient copayments and coinsurance; utilization management tools; potential changes to Medicare payment models.
- Medicaid: funding difficulties; cost-containment strategies; pricing reforms.
- Outlook and implications for the pharmaceutical industry: discord over how to tackle the budget deficit; political deadlock over healthcare reform; declining access to generous health benefits; evolving cost-containment strategies; increasing use of comparative effectiveness research; support for new healthcare models.
- Displays: 30 data-rich figures and tables.
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