Contents:

EXECUTIVE SUMMARY Scope Datamonitor insight into reimbursement Setting a premium price for a product to boost value sales can generate higher revenues than lowering its price to increase volume sales in a cost constrained market In competitive markets, product positioning through efficacy data in different populations and dosing advantages, rather than cost alone, are key to securing leadership For selected products, companies should consider launching outside reimbursement at a higher price point, as 50% of interviewed physicians would not rule out prescribing a non-reimbursed product if it was the most effective Datamonitor recommends that companies use cost-effectiveness data and collaborations with patient advocacy groups to improve their position in reimbursement negotiations INTRODUCTION: COMPARISON OF REIMBURSEMENT LEVELS Reimbursement: setting the framework for pharmaceutical strategies Introduction Cost containment: driver of stricter reimbursement levels Summary comparison of reimbursement environments Benchmarking patient coverage versus pricing levels Conclusions: the link between reimbursement, prices and pharmaceutical strategies Comparison of reimbursement levels across different therapy areas A summary analysis of therapeutic reimbursement patterns Conclusions: which types of diseases require particular attention when seeking reimbursement? Analysis and methodology for Chapters 2 and 3 The underlying question: how to maximize revenues? Datamonitor's approach to analyzing price, cost and prescribing patterns FULL REIMBURSEMENT SCENARIO: IMPACT ON PRESCRIBING PATTERNS Introduction to full reimbursement scenario High cost paired with high medical need: Taxol for ovarian cancer Disease overview Reimbursement status and prescribing rates for Taxol in the seven major markets Prescribing in highly competitive disease markets: the two leading statins The battle for the leading position: Zocor versus Lipitor Reimbursement status and prescribing rates for Zocor and Lipitor in the seven major markets Prescribing patterns for low cost drugs with limited efficacy: the use of penicillins Disease overview Reimbursement status and prescribing rates for Amoxil in the seven major markets Summary conclusions PARTIAL AND NO REIMBURSEMENT SCENARIO: IMPACT ON PRESCRIBING PATTERNS Introduction to partial and no reimbursement scenario High cost paired with moderate medical need: partial reimbursement of triptans in the treatment of migraine Disease overview Reimbursement status and prescribing rates for Imigran in the seven major markets Moderate medical need paired with high generic competition: superficial fungal infections in Spain and Italy Disease overview Reimbursement status and prescribing rates for Canesten in six major markets High cost paired with high medical need: no versus full reimbursement of Aricept in Europe Disease overview Reimbursement status and prescribing rates for Aricept in six major markets Summary conclusions IMPACT OF REIMBURSEMENT ON PHARMACEUTICAL STRATEGIES How are pharmaceutical companies currently addressing reimbursement? Overview of strategic options Pricing Marketing Meeting the needs of different audiences Payors Physicians Patients Summary Summary: recommendations for best reimbursement practice The two paths for increasing value sales APPENDIX A: REIMBURSEMENT AND PRICING REGULATIONS IN THE SEVEN MAJOR MARKETS The US The health insurance system Pricing system Japan The health insurance system Pricing developments France The health insurance system Pricing developments Germany The health insurance system Pricing developments Italy The health insurance system Pricing developments Spain The health insurance system Pricing developments The UK The health insurance system Pricing developments APPENDIX B: METHODOLOGIES References Methodology of this report Primary research Secondary research Exchange rates used Sales data research methodology Introduction Hypothesis formulation Hypothesis testing Data verification with key contacts Quality control Quantification of data reliability Research methodology for Datamonitor's Treatment Algorithms series Introduction Hypothesis formulation Physician recruitment Hypothesis testing Quality control Pricing data research methodology Introduction Hypothesis formulation Hypotheses testing Quality control Quantification of data reliability