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Pharmaceutical Pricing, Reimbursement, and Prescribing News in the Third Quarter of 2005
Decision Resources, Inc., Nov 2005, Pages: 17
In terms of developments in the pricing, reimbursement, and prescribing environment, the third quarter of 2005 was relatively uneventful in the United States and Japan but busy in much of Europe. In the United States, criticism of pharmaceutical prices continued as the health care system prepared for the launch of the Medicare prescription drug benefit. The French government proposed tough cost-containment measures for 2006. In Germany, uncertainty about the composition and health care policies of the new government prevailed. The Italian government was quiet, but the Spanish government refined its proposals for a new medicines law that would be onerous for the industry. In the United Kingdom, the government largely rejected a parliamentary report that criticized the pharmaceutical industry. Intensive lobbying by industry associations in Japan raised hopes of long-awaited reforms of the pricing and reimbursement system.
Business Implications
- In the United States, Medicare beneficiaries who have traditional fee-for-service (FFS) coverage will have access to prescription drug plans that will fill the coverage gap. Such plans are likely to charge a higher premium (typically $50-60 per month). Alternatively, beneficiaries will be able to obtain their prescription drug coverage through a Medicare Advantage plan (e.g., a Medicare health maintenance organization [HMO] or preferred provider organization [PPO]). The Centers for Medicare and Medicaid Services forecasts that 70% of Medicare beneficiaries will have access to Medicare Advantage plans that charge no premium for the Medicare prescription drug benefit. Some Medicare Advantage plans are also expected to waive premiums for benefits that fill the coverage gap.
- The French government is looking to the pharmaceutical industry to deliver savings of €2.1 billion ($2.6 billion) in 2006, including a 3.3% reduction in spending on medicines. The sales tax on drug manufacturers will be increased from the current rate of 0.6% to 1.5%. Companies that exceed their agreed sales limits will be required to refund 70% of the excess. From January 1, 2006, prices of off-patent drugs will be cut by 13%. Reference prices will automatically be imposed two years after the patent on a compound expires. The use of three-month packs of medicines for chronic disorders will be encouraged (where appropriate). From March 1, 2006, 156 products will be dereimbursed and 62 products will have their reimbursement rate reduced to 15%.
- A survey of 275 pharmaceutical companies in Germany found that 84% believed that the Statutory Health Insurance Act’s impact on
drug manufacturers had been either bad or very bad. Thirty-eight percent of companies have reduced their number of employees: the median decrease was 10%. In addition, 33% of companies indicated that they had cut their spending on R&D: the median decrease was 20%, but some companies reported that they had discontinued R&D entirely.
- The Spanish government intends to moderate its proposed pharmaceutical reforms A measure to cut the price of older drugs by 20% will be restricted to drugs that are available as generics in at least one EU member state, thereby reducing the number of drugs affected by approximately two-thirds. The introduction of a new reference pricing system may be postponed until March 2007, and products that offer useful “incremental innovations” may qualify for a temporary price premium. However, the government appears unlikely to yield to pressure to abolish its new sales tax and could dereimburse the products of manufacturers that refuse to pay this tax.
- Pharmaceutical industry associations in Japan have called for radical reforms to the pricing and reimbursement system. They argue
that price premiums for therapeutic advances should be awarded more liberally; biennial price revisions should be abolished in the case of patent-protected drugs; and the repricing of drugs that exceed sales forecasts should be discontinued. Instead, they favor a system that would allow manufacturers to suggest reimbursement prices for new drugs, based on factors such as manufacturing costs and prices in other countries.
Also available
Pharmaceutical Pricing, Reimbursement, and Prescribing News in the First Quarter of 2005
Pharmaceutical Pricing, Reimbursement, and Prescribing News in the Second Quarter of 2005
Pharmaceutical Pricing, Reimbursement, and Prescribing News in the Fourth Quarter of 2005
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