Pharmaceutical Pricing, Reimbursement, and Prescribing News in the Fourth Quarter of 2007

Published by: Decision Resources

Published: Jan. 31, 2008 - 30 Pages

Table of Contents

Executive Summary

Strategic Considerations

Stakeholder Implications

Overview

United States

Temporary Measures to Defer Medicare Reimbursement Cuts and Prolong Basic Health Insurance for Children

Decline in Drug Imports

Pressure for the Introduction of a Medicare Formulary

PBMs Commit to Greater Transparency

Call for Infl ation-Based Medicaid Rebates

Copayment Reductions and Waivers for Generics and Chronic Disease Therapies

Momentum for Universal Health Insurance

Benefi t Cuts at Age 65 Judged Acceptable

European Union

Responses to Public Consultation on the Future of Pharmaceuticals in Europe

France

French Health Care System at a Crossroads

Social Security Budget Increases Pressure on Pharmaceutical Industry

Potential Reform of Coverage of Treatments for Chronic Diseases

Germany

Market Trends in 2007

Pharmaceutical Budget for 2008

Introduction of New Reference Pricing Groups

Continuing Debate Over Procedures for Health Economic Evaluation

Continued Growth in Rebate Contracts

Italy

Market Trends

Spain

Amendments to the Reference Pricing System

United Kingdom

Proposed Amendments to NICE’s Methods for Technology Appraisals

OFT Report on Direct-to-Pharmacy Distribution

Abolition of Prescription Charges in Scotland

Japan

Overhaul of Pricing and Reimbursement System Unlikely in 2008

Change to Prescription Form to Stimulate Generics Substitution

Outlook and Implications for the Pharmaceutical Industry

Tables:

1. New Reference Pricing Groups Implemented in Germany Effective January 1, 2008

2. 2007 Retail Prices and New Reference Prices of Largest Pack Size of Nebilet

3. Proposed Changes to the Hierarchy of National Health Insurance Price Premiums in Japan

4. Revision Rates for Japanese Reimbursement Prices, 1994-2006

Figures:

1. Uninsured U.S. Residents, 2002-2006

2. Ten Most Common Registered Chronic Diseases in France, 2006

3. Annual Sales of Drugs Facing Patent Expiration in Italy in 2008

Abstract

• Pending U.S. legislation would allow the Department of Health and Human Services to create a national Medicare formulary. How would HHS use this formulary in its price negotiations with pharmaceutical manufacturers?
• U.S. employers and health plans are recognizing the fi nancial and health benefi ts of promoting greater use of generic drugs and improved adherence to chronic disease therapy. What strategies are they pursuing in their efforts to improve patient adherence with chronic disease therapy and encourage the use of generics?
• Pressure to tackle the growth in the ranks of uninsured U.S. residents is mounting. Which states have enacted their own universal coverage legislation? How will the presidential election affect this issue at the national level?

• Overview: major events in the fourth quarter of 2007 in the pricing, reimbursement, and prescribing environment in the major pharmaceutical markets under study.
• United States: leading stories in 2007, including SCHIP, decline in drug imports, copayment reductions and waivers for generics and chronic disease therapies, and many others.
• European Union: responses to public consultation on the future of pharmaceuticals in Europe.
• France: pressures on pharmaceutical industry, potential reforms for chronic disease treatments.
• Germany: new reference pricing groups, health economic evaluation, growth in rebate contracts.
• Italy: market trends in 2007.
• Spain: amendments to the reference pricing system.
• United Kingdom: proposed amendments to NICE’s methods for technology appraisals, OFT report on direct-to-pharmacy distribution, abolition of prescription charges in Scotland.
• Japan: delay in overhaul of pricing and reimbursement system, efforts to increase use of generics.
• Outlook and implications for the pharmaceutical industry: the outlook for pharma in the United States, Europe, and Japan.

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