Pharmaceutical Pricing, Reimbursement, and Prescribing News in the Fourth Quarter of 2006

This publication has been discontinued on December 21, 2011.

Introduction

Abstract

Introduction:

Implementation and refinement of existing pricing and reimbursement initiatives throughout the major pharmaceutical markets continued to be a major theme in the fourth quarter of 2006. In the United States, preparations continued for the second year of the Medicare Part D prescription drug benefit. In Europe, while the European Union took action to promote common standards for health technology assessment, individual governments continued to pursue independent national cost-containment strategies. And in Japan, implementation of revised price premiums earlier in the year has benefited manufacturers of useful and innovative drugs.

Get the Answers You Need to Shape Your Strategy:

• In the United States, the midterm Congressional elections dominated the news. What implications will this change of power have on U.S. health care policy? How will the pharmaceutical and biotechnology industries respond to this new political landscape?
• The German government has proposed significant health care reforms. How will these reforms affect health insurance, physician reimbursement, hospitals, and the pharmaceutical market? What new freedoms and what new constraints will result?
• Governments in the major pharmaceutical markets continue to refine regulations on drug pricing and reimbursement. How will these refinements affect the pharmaceutical markets in these countries? Will certain drug classes in certain countries actually benefit from these reforms?
• The steady expansion of reference pricing across Europe exemplifies governments' tendency to imitate each other, while they simultaneously pursue their disparate national strategies for containing health care costs. In such a climate, is there any hope for harmonized reimbursement standards?

Scope:

• Fourth quarter news in 2006: major events in the pharmaceutical pricing, reimbursement, and prescribing environment in the United States, Europe (France, Germany, Italy, Spain, and the United Kingdom), and Japan.
• Cost-containment programs: measures that health care payers are using to curb their drug expenditures and to improve patient access to medications.
• Outlook: our assessment of the implications of these events for the pharmaceutical industry in the major markets under study.

Mentioned in This Spectrum Report:

Organizations:

• Agence Francaise de Sécurité
• Sanitaire des Produits de Santé (AFSSAPS; French Agency for the Safety of Health Products)
• Allgemeine Ortskrankenkassen (Local General Health Insurance Funds)
• Biotechnology Industry Organization (BIO)
• Bundesfachverband der Arzneimittelhersteller(BAH; Federal Association of Pharmaceutical Manufacturers)
• Bundesverband der Betriebskrankenkassen (BKK;Federal Association of Occupational Health Insurance Funds)
• Bundesvereinigung Deutscher Apothekerverbande(ABDA; Federal Union of German Pharmacists' Associations)
• Centers for Medicare and Medicaid Services (CMS)
• Chuikyo (Central Social Insurance Medical Council)
• Department of Veterans Affairs (VA)
• European Network for Health Technology Assessment (HTA)
• Farmaindustria Gemeinsamer Bundesausschus der Ärzte,Zahnärzte, Krankenhäuser und Krankenkassen(GBA; Joint Federal Committee of Physicians, Dentists, Hospitals, and Health Insurance Funds)
• Gesetzliche Krankenversicherung (GKV; statutory health insurance)
• Haute Autorité de Santé (HAS; National Health Authority)
• High-Level Group on Innovation and the Provision of Medicines (G10 Medicines Group)
• High-Level Pharmaceutical Forum
• House Energy and Commerce Committee' s Subcommittee on Health
• Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG; Institute for Quality and Economy in the Health Care System)
• Kassenärztliche Bundesvereinigung (KBV; Federal Union of Health Insurance Fund Physicians)
• National Health Service (NHS)
• National Institute for Health and Clinical Excellence (NICE)
• Osservatorio Nazionale sull' Impiego dei Medicinali (OsMed; National Observatory on Pharmaceutical Spending)
• Servizio Sanitario Nazionale (SSN; National Health Service)
• Sistema Nacional de Salud (SNS; National Health System)

Companies:

• EnvisionRx Plus
• Express Scripts
• First Databank
• Health Net
• Humana
• Ipsen
• Longs Drug Stores
• McKesson
• Medi-Span
• Merck KGaA
• NewQuest Health Solutions
• NMHC Systems
• Roche
• Thomson' s Red Book
• Torchmark

Table of Contents

• Executive Summary
  • Strategic Considerations
  • Stakeholder Implications
• Introduction
• United States
  • Impact of Congressional Elections
  • Changes to Medicare Part D
  • Medicaid Reform
  • Average Wholesale Price Measure Under Threat
• European Union
  • European Cooperation on Health Technology Assessment
• France
  • New Wave of Reimbursement Cuts
  • Impact of Government' s Medical Control Strategy
• Germany
  • Slowdown in Pharmaceutical Spending
  • Proposed New Health Care Reforms
  • Daily Cost-of-Therapy Limits
  • Many Products Exempted from Copayments
  • Reference Price Adjustments for 2007
• Italy
  • Price Cuts Slow Sales Growth
• Spain
  • Industry Requests Price Increase
  • New Reference Pricing System Authorized
• United Kingdom
  • Clarifi cation of NICE' s Role in the National Health Service
  • Courts Rule on Access to Drugs Rejected by NICE
• Japan
  • Reform of the Pricing and Reimbursement System Deferred
  • Higher Price Premiums for Innovation
• Outlook and Implications for the Pharmaceutical Industry

Tables:

• 1: Key Features of Standard Medicare Part D Drug Benefit, 2006 and 2007
• 2: German Daily Cost-of-Therapy Limits, 2007

Figures:

• 1: Percentage of Stand-Alone Prescription Drug Plans Charging Various Monthly Premiums,2006 and 2007
• 2: Percentage of Medicare Advantage Plans Charging Various Monthly Drug Premiums,2006 and 2007
• 3: Percentage of Stand-Alone Prescription Drug Plans Levying Various Drug Deductibles,2006 and 2007
• 4: Percentage of Medicare Advantage Plans Levying Various Drug Deductibles, 2006 and 2007
• 5: Percentage of Stand-Alone Prescription Drug Plans Offering Various Levels of Drug Coverage in the Coverage Gap, 2006 and 2007
• 6: Percentage of Medicare Advantage Plans Offering Various Levels of Drug Coverage in the Coverage Gap, 2006 and 2007
• 7: Monthly Pharmaceutical Expenditures of Germany' s Statutory Health Insurance System, January 2003-October 2006
• 8: Infl uences on Pharmaceutical Expenditures in Germany' s Statutory Health Insurance System, April-October 2006

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