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Pharmaceutical Pricing and Reimbursement: Global Markets

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  • 164 Pages
  • July 2020
  • Region: Global
  • BCC Research
  • ID: 5125535
UP TO OFF until Aug 31st 2033

Report Scope:

This new report on pricing and reimbursement in a global market provides a brief overview of the pharmaceutical markets, healthcare reforms, and regulations across the globe over the last decade and how this has impacted mergers and acquisitions and venture capitalist investment in the sector. It reviews pricing and reimbursement policies and processes in the U.S. and Europe and the ways in which pharmaceutical investment in generics, biosimilars, over the counter (OTC), small molecule and biological agents; and the shift toward more innovative medicines such as cell and gene therapies may change future treatment paradigms and future pricing and reimbursement policies.

Report Includes:

  • An overview of the global markets for pharmaceuticals, specifically healthcare legislation and regulation, pricing mechanisms, and reimbursement procedures
  • Analyses of the global market trends, with data corresponding to market size for 2014-2019, and projections of compound annual growth rates (CAGRs) through 2024
  • Information on the current price and reimbursement landscape, benchmarking statics, and future development opportunities in the pharma industry
  • Case studies of different price and reimbursement strategies for prescription drugs, orphan drugs, generics, over-the-counter products, and value-based pricing
  • Discussion on the impact of COVID-19 on pharmaceutical sales in Q1 2020 and overall healthcare marketplace
  • Insight into the greater adoption of value-based pricing schemes, with emphasis on the innovative payment models, increased investment in cell and gene therapies, and long-term response to COVID-19

Table of Contents

Chapter 1 Introduction

  • Study Goals and Objectives
  • Reasons for Doing This Study
  • Scope of Report
  • Information Sources
  • Methodology
  • Geographic Breakdown
  • Analyst's Credentials
  • Custom Research
  • Related Reports

Chapter 2 Summary and Highlights

Chapter 3 Global Healthcare Expenditures, Legislation and Pricing Mechanisms

  • Global Healthcare Costs
  • Forecasts Pre-COVID
  • Forecasts Post-COVID
  • Acute Healthcare Response to COVID-19
  • Expansion of Low-Cost Digital Services
  • Funding for COVID-19 Research and Development
  • Drug Expenditures
  • North America
  • Europe
  • Japan
  • BRIC Economies
  • Impact of COVID-19 on Pharmaceutical Sales in Q1 2020
  • Mergers and Acquisitions (M&A)
  • M&A Activity Pre-2019
  • M&A Activity in 2019
  • M&A Activity in Q1 2020
  • Healthcare Reforms
  • France
  • Germany
  • Italy
  • Spain
  • United Kingdom
  • United States
  • Pharmaceutical Regulation
  • France
  • Germany
  • Italy
  • Spain
  • United Kingdom
  • United States
  • Acute Impact of COVID-19 on Healthcare
  • France
  • Germany
  • Italy
  • Spain
  • United Kingdom
  • United States

Chapter 4 Pricing Strategies

  • Introduction
  • Primary Reasons for the Rise in the Cost of Pharmaceuticals
  • Replacement of Older, Lower-Cost Drugs by Newer, Higher Priced Drugs
  • Increased Use of Drugs
  • New Drugs for Diseases for Which No Treatment Was Previously Available
  • Increases in the Prices of Existing Medicines
  • Pharmaceutical Pricing Strategies
  • External Price Referencing
  • Internal Referencing Pricing
  • Prescription Drug Pricing
  • United Kingdom
  • United States
  • Over-the-Counter (OTC) Drug Pricing
  • Europe
  • United Kingdom
  • United States
  • Generic Drug Pricing
  • United Kingdom
  • United States
  • Orphan Drug Pricing
  • Value-Based Pricing
  • Open Tender Invitations and Procurement
  • Framework Agreements

Chapter 5 Reimbursement Strategies

  • Pharmaceutical Reimbursement
  • Admission to Reimbursement
  • Reimbursement Procedure
  • Europe
  • United Kingdom
  • United States
  • Hospital Reimbursement
  • Europe
  • United Kingdom
  • United States
  • Patient Access Schemes
  • Financially Based Schemes
  • Outcome-Based Schemes
  • Early Access to Medicines Schemes
  • Europe
  • United Kingdom
  • United States
  • Formulary Lists
  • Europe
  • United Kingdom
  • United States
  • Health Technology Assessments (HTA)
  • Europe
  • United Kingdom
  • United States
  • The Value of Health Economics and Outcome Research (HEOR)
  • Top 10 HEOR Trends

Chapter 6 The Future

  • Greater Adoption of Value-Based Pricing Schemes
  • Increased Investment in Cell and Gene Therapies
  • Innovative Payment Models
  • Greater Clarity on Brexit
  • Political Wrangling Over Drug Prices
  • Long-term Response to COVID-19 Undefined

Chapter 7 References

List of Tables
Table 1: Major Market Drivers of Global Healthcare Expenditures
Table 2: Total Healthcare Expenditure in G20 Economies, 2018
Table 3: Inpatient Care Average Length of Stay in All Hospitals, 2014
Table 4: Steps Implemented to Access Diagnostics and Treatment Following the COVID-19 Pandemic
Table 5: Steps Implemented to Boost and Optimize Healthcare Capacity
Table 6: COVID-19 Vaccines under Development
Table 7: COVID-19 Treatments under Development
Table 8: Major Mergers and Acquisitions in the Global Pharmaceutical Market, 2019
Table 9: Major M&A Deals in the Global Pharmaceutical Market, Q1 2020
Table 10: Allowed Growth Rates, 2014-2018
Table 11: Net Revenues Retained in the U.S. Pharmaceutical Market, by Type of Prescription Drug Participant, 2016
Table 12: Pricing of Medicines in Europe
Table 13: Using Market Forces to Price Generics in the U.K.
Table 14: Pricing Policies for Biosimilars in Europe, as of April 2017
Table 15: National Authorities in Charge of Market Authorization, Pricing, and Reimbursement in the EU5 Countries
Table 16: Federally Funded Health Insurance Programs in the U.S.
Table 17: An Overview of Early Access Schemes
Table 18: Example of a Five-Tier Formulary System in the U.S.
Table 19: Acronyms Used in the Global Pharmaceutical Pricing and Reimbursement Market

List of Figures
Figure 1: Projected Annual Growth in Global Healthcare Spending, 2020
Figure 2: Global GDP Growth Forecast Comparison, February 2020 vs. May 2020
Figure 3: Overview of Coronavirus Impact Index, by Industry
Figure 4: Potential Initial Impact of Partial or Complete Shutdowns on Activity in the G7 Economies
Figure 5: Schematic Diagram of Global Healthcare Spend to Increase, 2020
Figure 6: Trends in Global Pharmaceuticals Sales, by Market Segment, 2018-2024
Figure 7: Projected Annual Growth Forecast in Global Pharmaceutical Market, by Region Group, 2018-2022
Figure 8: Market Shares of Generic Medicine Sales in Selected European Countries, as of 2016
Figure 9: Cumulative Pharmaceutical M&A Spending Comparison, 2019 vs. 2018
Figure 10: Healthcare Reforms in Germany
Figure 11: Worldwide Confirmed Cases and Number of Fatalities from COVID-19, as Reported by WHO, as of May 24, 2020
Figure 12: Regional Confirmed Cases and Number of Fatalities from COVID-19, as Reported by WHO, as of May 24, 2020
Figure 13: European Countries Where External Reference Pricing is Used
Figure 14: Overview of Countries that Refer to the U.K.
Figure 15: European Countries Where Internal Reference Pricing is Used
Figure 16: NHS Spending on Prescription Pharmaceuticals, 2010-2018
Figure 17: Pharmaceutical Pricing Process in the U.S.
Figure 18: Countries Using Generic Prices in Europe
Figure 19: Share of Generic Drug Sales (by Value and Volume) Across the OECD Nations, 2014
Figure 20: Comparing Prices of Biosimilars and Branded Products
Figure 21: U.S., EU and Japan Orphan Designations per Year and Cumulative, 1983-2016
Figure 22: Top 100 Orphan Drug Costs per Patient per Year in the U.S., 2012-2016
Figure 23: Value-Based Pricing Process in the U.K.
Figure 24: Overview of Pharmaceutical Tendering Process
Figure 25: Overview of the Application of Reimbursement Schemes in Europe
Figure 26: Organization of the U.S. Healthcare System
Figure 27: U.S. Healthcare Expenditures as a Share of GDP, by Source of Funds, 1987-2018
Figure 28: Organization of the Healthcare System in England
Figure 29: Evolution of PAS England, 2007-2015
Figure 30: PAS Approval Process (Simplified Version)
Figure 31: Pathways for Accessing an Orphan Therapy in the EU
Figure 32: Three-Stage EAMS Process in the U.K.
Figure 33: Types of Reimbursement Lists Used in the Outpatient Sector Europe
Figure 34: Process of Identifying if an Item Can be Prescribed on the NHS
Figure 35: Two Simplified Examples of HTA Utilization in Europe
Figure 36: Tools and Disciplines Involved HEOR Analysis
Figure 37: Elements of Value-Based Pricing
Figure 38: Global Cell and Gene Therapy Market, 2018 vs. 2024
Figure 39: Innovative Payment Models for Cell and Gene Therapies
Figure 40: Four Waves of COVID-19 on Healthcare



Executive Summary

During the first quarter of 2020, most pharmaceutical companies, such as Bristol-Myers Squibb, GlaxoSmithKline, Eli Lilly, Johnson & Johnson, and Novartis, witnessed a short-term boost in sales as wholesalers stockpiled products due to supply chain concerns. Some areas such as physician or hospital administered medications and travel vaccines saw a decline in sales, for obvious reasons.

Mergers and acquisitions (M&A) activity in the pharmaceutical sector keeps ticking along, with 2019 being one of the most active years in the last decade, many transactions involved the acquisition of cell and gene therapies and immune-oncology assets or to diversify risks through the adoption of digital technologies and artificial intelligence (AI).

To contain healthcare costs, governments across the globe have introduced healthcare reforms and initiated new legislation and pharmaceutical regulations that look more closely at the performance and cost-effectiveness of care. The pharmaceutical regulatory landscape is highly fragmented and divergent, and the following section summarizes the regulatory processes adopted by the latest top five European countries and the U.S. However, as regulatory oversight increases there is a growing need for regulatory harmonization.

Since the first reports of COVID-19 in Wuhan, China in December 2019, there have been 5,165,481 confirmed cases and over 336,430 confirmed deaths in 216 countries worldwide, as of May 24, 2020. Relatively few countries remain unscathed by the pandemic and scientists across the globe have worked together to advise local, regional and national healthcare organizations to contain the spread of the disease and develop prophylactic vaccinations and new therapies to treat the symptoms of the viral infection. Each country has adopted its own healthcare strategies and mobilized resources based on their individual circumstances, but only by working together will the world be able to combat this lethal disease.

More than $830 million in funding has been pledged to support R&D efforts in COVID-19, and health tech and pharmaceutical companies are working together in public-private collaborations, while numerous diagnostics, vaccines, and treatments are already under development and research.

The COVID-19 pandemic has already dramatically changed healthcare delivery, and the economic impact of COVID-19 pandemic on healthcare spending is unknown. It will depend on many factors including level and severity of infection, availability of diagnostics prophylactic treatments and vaccines, and whether the health system can manage supply constraints and defer non-essential healthcare services.

Companies Mentioned

  • Bristol-Myers Squibb
  • Eli Lilly
  • GlaxoSmithKline
  • Johnson & Johnson
  • Novartis