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Pharmaceutical Pricing and Reimbursement in the United States, 2008
Decision Resources, Inc., Feb 2008, Pages: 74
Introduction
The United States dominates the world’s pharmaceutical markets, not least because it offers pharmaceutical companies a speedy, efficient drug registration process and unrivaled freedom to negotiate drug prices and reimbursement—but a rising chorus of complaint about the high cost of branded drugs is driving public and private sector policy changes, and companies must prepare to deal with difficult challenges. This report features a summary of 12 areas of change and identifies the implications of those trends for the U.S. drug industry.
Get the Answers You Need to Shape Your Strategy
- One of the most attractive features of the U.S. market for pharmaceutical companies is the unrivalled freedom of its pricing and reimbursement environment. How has the Deficit Reduction Act of 2005, in effect since January 2007, changed drug manufacturers’ “best-price” calculations? How are pharmacy benefit management (PBM) companies’ relationships to drug companies evolving in response to widespread criticism? What are CMS and commercial insurers doing to curb expenditure on provider reimbursement?
- Medicare drug spending is forecast to grow from just $2 billion in 2000 to $153 billion in 2016—a 7,550% increase. How will this enormous growth in Medicare’s share of total U.S. drug expenditures affect private insurers? Will it encourage employers to reduce or eliminate retiree benefits? How might the 2008 Medicare drug benefit design influence drug design in the non-Medicare market?
- Cost-containment pressures will continue to intensify and force all payers to look for substantial
economies. Will patient co-payment and coinsurance rates rise? What other methods are health plans using to control costs? Will Congress enact a regulatory framework for bio-generics approval in 2008? How will these efforts impact the pharmaceutical industry?
- The most radical changes to the U.S. pharmaceutical market could result from the outcome of the 2008 presidential and congressional elections. How do the contending parties differ on the question of universal health insurance? How do they differ on ways to control health care costs, particularly drug costs?
Scope
- U.S. health care system: Organization and funding, Medicare, Medicaid, private insurance, military and other federal health care programs.
- Pharmaceutical prices in the United States: Relative to other major markets, public and private sector pricing, generics pricing.
- Provider reimbursement: Medicare, commercial insurers.
- Coverage decision making: Public and private sectors.
- Cost-containment measures: Multi-tier formularies, patient co-payments and coinsurance, use of generics, therapeutic substitution, step therapy, prior authorization, specialty pharmacy.
- U.S. pharmaceutical market outlook: Slower growth, impact of Medicare Part D, intensifying cost-containment pressures, insurers’ growing use of comparative drug effectiveness data, possible market entry of bio-generics by 2009.
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