Pharmaceutical Pricing and Reimbursement - Reference Pricing and Economic Evaluations Will Dominate Future Pricing and Reimbursement Strategies

GBI Research
February 1, 2010
83 Pages - SKU: XGBR2584304
  • Executive Summary
    • (Table) Figure 1: Major Pricing and Reimbursement Strategies Employed Across the Globe
    • (Table) Figure 2: Impact Analysis: Pricing and Reimbursement Issues Across the Globe
  • Introduction
    • GBI Research Report Guidance
  • Pharmaceutical Pricing & Reimbursement Issues at Global Level – Innovative Mechanisms To Decrease the Healthcare Costs
    • Introduction
      • (Table) Figure 3: Comparison of Per Capita Expenditure on Health at Average Exchange Rate ($) v/s Life Expectancy, 2006
      • (Table) Figure 4: Comparison of CAGR of R&D Expenditure v/s Turnover Over the Last Five Years for the Top 5 Companies, 2003–2008
    • Issues at Global level
      • Value Based Pricing and Risk-Sharing Models
        • (Table) Figure 5: Value Based Pricing – Concept and Process
        • (Table) Figure 6: Impact Analysis: Value Based Pricing
      • Increased Focus on Evidence-based Medicine and Health Technology Assessment (HTA)
        • (Table) Figure 7: Drivers and Restraints for EBM (Evidence Based Medicine)
        • (Table) Figure 8: Impact Analysis: Evidence Based Medicine
      • Role of Pharmacoeconomics in Pricing and Reimbursement
        • (Table) Figure 9: ISPOR 33 Guidelines for Pharmacoeconomics Assessment
        • (Table) Examples of Pharmacoeconomic Evaluations in Ireland
        • (Table) Figure 10: Impact Analysis: Pharmacoeconomics
    • Conclusion
  • Pricing and Reimbursement Issues in US – Government’s Cost Rationalization Efforts Will Make Future Tough for Big Pharma
    • (Table) Figure 11: Average Annual Percentage Change in Manufacturer Prices for Most Widely Used Prescription Drugs in US
    • New Nationwide Database to Set Healthcare Reimbursement Rates
      • (Table) Figure 12: Case: An Example Of Data Tampering To Provide Artificially Low Reference Prices For Reimbursements Of Out-Of-Network Medical Expenses
      • (Table) Figure 13: Impact Analysis: New Database for Reimbursement Rates of Out-of-Network Medical Expenses
    • Medicaid Pricing for Dual Eligibles of Medicare Part - D
      • (Table) Figure 14: Comparison of Medicare Part D and Medicaid Discounts
      • (Table) Drug Manufacturers Receiving Largest Windfalls, ($m), 2006–2007
      • (Table) Figure 15: Impact Analysis: Medicaid Pricing for Dual Eligibles in MPD (Medicare Part D)
    • New ICD-10 (International Classification of Diseases - 10) Coding System
      • (Table) Figure 16: ICD-10 Coding System; Features and Benefits
      • (Table) Figure 17: Impact Analysis: ICD-10 Coding System
    • Generic Price War at Retail Sector
      • (Table) Figure 18: Impact Analysis: Generic Price War
    • MIPPA (Medicare Improvement for Patients and Providers Act), the AMP Rule Litigation
      • (Table) Figure 19: Impact Analysis: MIPPA (Medicare Improvement for Patients and Providers Act)
    • First DataBank/Medi-Span Settlement and the Impact on AWP
      • (Table) Figure 20: Impact Analysis: First DataBank/Medi-Span Settlement
    • Conclusion
  • Pricing and Reimbursement Issues in Western Europe – Cost-Effectiveness is the Key to Success
    • Parallel Trade
      • (Table) Figure 21: Parallel Import Market Break-down, Europe, 2007, Total Size = $7.5bn
      • (Table) Figure 22: Impact Analysis: Parallel Trade
    • EU Single Pricing - Still an Issue
      • (Table) Figure 23: Price Level Indices for Pharmaceutical Products, EU25 = 100, 2005
      • (Table) Figure 24: Impact Analysis: EU Single Pricing
    • International Price Referencing
      • (Table) Figure 25: Impact Analysis: International Reference Pricing
    • Status quo of P&R in Western Europe
      • (Table) Pricing and Reimbursement Mechanisms in Western European countries
      • UK
      • France
      • Germany
      • Italy
      • Spain
    • Conclusion
  • Pricing and Reimbursement Issues in Central & Eastern Europe (CEE) and Scandinavia – Reference Pricing and Centralization Proves Detrimental for High Price Drugs
    • Central & Eastern Europe – Cost-Effectiveness is of Paramount Importance
      • (Table) Pricing and Reimbursement Mechanisms in Czech Republic, Romania, Austria, Poland and Hungary
      • (Table) Different Pricing Mechanisms used in Czech Republic, Poland, Austria, Romania and Hungary
      • Czech Republic
      • Poland
      • Austria
        • (Table) Box Model for Reimbursement in Austria
      • Romania
      • Hungary
        • (Table) Figure 26: Overshooting Actual Budget Expenditure, Hungary,(%), 1994–2005
    • Scandinavia – Moving Towards Centralized Healthcare Regime
      • (Table) Comparative Analysis of Per Capita Healthcare Expenditures in the Scandinavian Countries, 2006
      • (Table) Pricing and Reimbursement Mechanisms in the Scandinavian Countries
      • Denmark
      • Norway
        • (Table) Norway - Step Price System, 2008
      • Sweden
      • Future Landscape
    • Conclusion
      • (Table) Figure 27: Impact Analysis: P&R Issues in CEE and Scandinavia
  • Pricing and Reimbursement Issues in Asia-Pacific – Negative Pricing Pressures Leaves Less Hope for Expensive Medicines
    • DPC (Diagnosis Procedure Combination) Reimbursement System in Japan - Immense Savings for the Government
      • (Table) Trend in the Revision Rates of Reimbursement Prices in Japan, 1992–2008
      • (Table) Figure 28: Impact Analysis: DPC (Diagnosis Procedure Combination) Reimbursement System
    • Reforms in Chinese Pharmaceutical Market: Tougher Landscape for Generic and Off-Patent Brands
      • (Table) Figure 29: Sales in Pharmaceutical Industry, China, $m, 1998–2008
      • (Table) Sales in Pharmaceutical Industry, China, $bn, 1998–2008
      • Active Ingredient Based Reimbursement: Restricted Market for Original Branded Products
        • (Table) Figure 30: Increase in the Per Capita Expenditure for Medical Services in the Urban and Rural Households, China, ($m), 1990–2006
        • (Table) Increase in the Per Capita Expenditure for Medical Services in the Urban and Rural Households, China, $m, 1990–2006
      • New Regulatory Reforms: Stricter Rules for Innovation Seal
      • Price Cuts and Hospital Tendering Process: Erosion of Generic Margins
        • (Table) Ratio of Retail v/s Wholesale Price in Eight European Countries and China, 2005
      • Future Scenario: Innovation is the Key for Western Pharmaceutical Companies
        • (Table) Figure 31: Impact Analysis: Reforms in Chinese Pharmaceutical Market
    • Transparency Issues with PBS in Australia
      • AUSFTA (Australia-United States Free Trade Agreement) - Boon for Branded Pharma
        • (Table) Figure 32: Arguments For and Against the AUSFTA
        • (Table) Figure 33: Impact Analysis: AUSFTA
      • Access Issues for HCM (High Cost Medicines) and Controversial Selection Criteria
      • Consumer Participation in the PBS Drug Listing - A Move towards Greater Transparency and Cost-Efficiency
    • Conclusion
  • Pricing and Reimbursement Issues for Orphan Drugs – Excessive Prices of Orphan Drugs Increasing Financial Pressures on Government
    • (Table) Definition and Incentives for Orphan Drugs in US, EU, Japan and Australia
    • Exploiting Orphan Drug Act; Maximizing Revenues
      • (Table) Figure 34: Number of Orphan Drugs Approved by FDA, 2000–2009
      • Ovation’s Indocin and Questcor’s H.P. Acthar Gel
    • Pricing of an Orphan Drug
      • (Table) Figure 35: Factors Influencing the Pricing of an Orphan Drug
      • (Table) Figure 36: Correlation Between the Prevalence and the Annual Cost of Therapy for Orphan Drugs
    • Price Control Measures
      • Global Approach for Orphan Drug Development
      • Introducing Sales Ceiling and Flexible Market Exclusivity
      • Price Revisions
    • Conclusion
      • (Table) Figure 37: Impact Analysis: Price Control Measures on Orphan Drugs
  • Key Takeaway
 

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