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Market Research Report

Pharmaceutical Pricing and Reimbursement - Adoption of Health Technology Assessments (HTA) Optimizes Drug Pricing and Accelerates Reimbursement Decision-Making

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Pharmaceutical Pricing and Reimbursement - Adoption of Health Technology Assessments (HTA) Optimizes Drug Pricing and Accelerates Reimbursement Decision-Making
Published: September 1, 2012 Content info: 68 Pages
Description

Summary

GBI Research, leading business intelligence provider has released its latest research report, entitled "Pharmaceutical Pricing and Reimbursement - Adoption of Health Technology Assessments (HTA) Optimizes Drug Pricing and Accelerates Reimbursement Decision-Making". The report provides a comprehensive overview of the healthcare system and pricing and reimbursement process in the US, top five countries of Europe (the UK, Germany, France, Spain and Italy), Japan, Australia and China, with a detailed analysis of the different regulatory mechanisms used in these countries. The report closely scrutinizes the major changes in pharmaceutical pricing and reimbursement in these nations in the recent past and their impact in the near future.

Pricing and reimbursement issues are geography-specific and mostly depend upon the economic conditions of the country in question. Governments in the different countries of Europe have been adopting various measures to bring uniformity to the prices of pharmaceuticals by introducing measures such as international price referencing, pharmacoeconomic evaluations, value-based pricing, internal price referencing, price capping, risk sharing models, and positive and negative price lists. The Value Based Pricing System (VBPS), which is in the process of being adopted by the UK, will only reimburse drugs that provide value to patients. In addition, there are issues with respect to orphan drugs since there are no specific regulations governing their pricing, and pharmaceutical companies are exploiting patients by aggressively pricing these therapeutics. Pricing and reimbursement affects many players in the economic environment such as political parties, pharmaceutical companies, regulatory authorities, and patients. This report analyzes the impact of pricing and reimbursement issues on the concerned stakeholders. The report provides information on the economic situation of different countries with statistical graphs and graphs that represent the expenditure made by respective governments with respect to GDP. The report also provides information on the different pricing and reimbursement mechanisms that are being used in the current environment.

Scope

  • A detailed study of the healthcare systems and roles of the key players in the respective pharmaceutical systems in the US, top five countries of Europe (the UK, Germany, France, Spain and Italy), Japan, Australia and China.
  • Analysis of the major pricing and reimbursement mechanisms in each country.
  • Key trends that have emerged from the recent changes brought about in pricing and reimbursement mechanisms.
  • Possible major challenges brought about by the enactment of changes in the pricing and reimbursement scenes in the countries covered.

Reasons to buy

  • Build an understanding of the key pricing and reimbursement mechanisms for pharmaceuticals in the key markets of Europe.
  • Optimize your investment through the identification and understanding of the changes in the regulatory mechanisms for pharmaceuticals in the economies covered.
  • Develop effective business strategies related to new drug launches through the analytical insight gained from key trends in the pricing and reimbursement scene for the countries covered.

Executive Summary

US Healthcare Expenditure Expected to Far Outpace GDP

Although already the world's number one healthcare spender in terms of percentage of Gross Domestic Product (GDP) and per capita, US health expenditure is set to grow to unprecedented levels following the implementation of the recently passed Affordable Care Act (ACA), states a new report by GBI Research.

The business intelligence firm's latest study* says that the United States spent $8,300 per person on healthcare in 2010, but is expected to outlay as much as $12,500 for each citizen by 2020.

Growth in healthcare expenditure is expected to be modest until 2014, when the addition of 19.6 million people to the Medicare program is expected to increase Medicaid spending by 18% and private sector spending by 7.9%.

A study conducted by the Congressional Budget Office (CBO) in the US estimated that the government could spend more than $1.8 trillion a year on Medicare and Medicaid by the end of the decade, climbing from the $1.1 trillion allocated for 2012.

However, while the richest country in the world's healthcare system continues to expand, it is emerging nations such as China, India and Brazil that will exhibit the most substantial growth as these governments aim to make basic healthcare more affordable to a wider demographic.

Unlike these developing nations and the US, healthcare spending in the European Union (EU) has fallen consistently since the economic downturn of 2008, with the UK, Italy and Spain cutting back at Compound Annual Growth Rates (CAGRs) of -4%, -3.3% and -4%, respectively during the period 2008-2010.

Pharmaceutical Pricing and Reimbursement - Adoption of Health Technology Assessments (HTA) Optimizes Drug Pricing and Accelerates Reimbursement Decision-Making

This report provides a comprehensive overview of the healthcare system and pricing and reimbursement process in the US, top five countries of Europe (the UK, Germany, France, Spain and Italy), Japan, Australia and China, with a detailed analysis of the different regulatory mechanisms used in these countries.

This report was built using data and information sourced from proprietary databases, primary and secondary research, and in-house analysis conducted by GBI Research's team of industry experts.

Table of Contents

Table of Contents

1. Table of Contents

  • 1.1. List of Tables
  • 1.2. List of Figures

2. Pharmaceutical Pricing and Reimbursement - Introduction

3. Pharmaceutical Pricing and Reimbursement - Global Economic Issues

  • 3.1. Trend in Global Pricing and Reimbursement Regime
  • 3.2. Trend Analysis of Healthcare Expenditure Per Capita
  • 3.3. Public Health Expenditure as a Percentage of Total Health Expenditure
  • 3.4. Out-of-Pocket Health Expenditure as a Percentage of Private Expenditure on Health
  • 3.5. Healthy Life Years beyond the Age of 65

4. Pharmaceutical Pricing and Reimbursement - Global Issues

  • 4.1. Reference Prices
  • 4.2. International Price Referencing Adopted to Contain Healthcare Expenditure
  • 4.3. Pharmaceutical Price Capping to Encourage the Use of Generic Drugs
  • 4.4. Positive and Negative Price Formulary to Provide More Clarity on Drugs Covered by Health Insurance
  • 4.5. Value-Based Pricing Systems and Risk-Sharing Models Evaluate Drugs Based on Value and Not Cost
  • 4.6. Single Pricing Strategy in the European Union is a Debatable Issue
  • 4.7. Faster Pricing and Reimbursement Decisions Ensure Quicker Medicine Access and Return on Investments
  • 4.8. Issues in Pricing and Reimbursement in Orphan Drugs
  • 4.9. Difficulty in Economic Evaluation of Orphan Drugs

5. Pharmaceutical Pricing and Reimbursement - Pricing and Reimbursement by Geography

  • 5.1. The US
    • 5.1.1. Macroeconomic Factors (PEST Analysis)
    • 5.1.2. Healthcare System in the Country
    • 5.1.3. Healthcare Expenditure as a Percentage of GDP
    • 5.1.4. Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure
    • 5.1.5. Drug Pricing and Reimbursement Authorities
    • 5.1.6. Issues in Pricing and Reimbursement

6. Top Five Countries of Europe

  • 6.1. Proposal to Speed Up Pricing and Reimbursement Decisions in Europe
  • 6.2. The UK
    • 6.2.1. Macroeconomic Factors (PEST Analysis)
    • 6.2.2. Healthcare System in the Country
    • 6.2.3. Healthcare Expenditure as a Percentage of GDP
    • 6.2.4. Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure
    • 6.2.5. Drug Pricing and Reimbursement Authorities
    • 6.2.6. Trends in Pricing and Reimbursement
  • 6.3. France
    • 6.3.1. Macroeconomic Factors (PEST Analysis)
    • 6.3.2. Healthcare System in the Country
    • 6.3.3. Total Expenditure on Healthcare as a Percentage of GDP
    • 6.3.4. Private Expenditure and General Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure
    • 6.3.5. Drug Pricing and Reimbursement Authorities
    • 6.3.6. Trends in Pricing and Reimbursement
  • 6.4. Germany
    • 6.4.1. Macroeconomic Factors (PEST Analysis)
    • 6.4.2. Healthcare System in the Country
    • 6.4.3. Total Expenditure on Healthcare as a Percentage of GDP
    • 6.4.4. Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure
    • 6.4.5. Drug Pricing and Reimbursement Authorities
    • 6.4.6. Trends in Pricing and Reimbursement
  • 6.5. Spain
    • 6.5.1. Macroeconomic Factors (PEST Analysis)
    • 6.5.2. Healthcare System in the Country
    • 6.5.3. Total Expenditure on Healthcare as a Percentage of GDP
    • 6.5.4. Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure
    • 6.5.5. Drug Pricing and Reimbursement Authorities
    • 6.5.6. Trends in Pricing and Reimbursement
  • 6.6. Italy
    • 6.6.1. Macroeconomic Factors (PEST Analysis)
    • 6.6.2. Healthcare System in the Country
    • 6.6.3. Total Expenditure on Healthcare as a percentage of GDP
    • 6.6.4. Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure
    • 6.6.5. Drug Pricing and Reimbursement Authorities and Procedures
    • 6.6.6. Trends in Pricing and Reimbursement

7. Pharmaceutical Pricing and Reimbursement - Asia-Pacific

  • 7.1. China
    • 7.1.1. Macroeconomic Factors (PEST Analysis)
    • 7.1.2. Healthcare System in China
    • 7.1.3. Total Expenditure on Healthcare as a Percentage of GDP
    • 7.1.4. Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure
    • 7.1.5. Pricing and Reimbursement Approval Process
  • 7.2. Japan
    • 7.2.1. Macroeconomic Factors (PEST Analysis)
    • 7.2.2. Healthcare System in the Country
    • 7.2.3. Total Expenditure on Healthcare as a Percentage of GDP
    • 7.2.4. Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure
    • 7.2.5. Revisions to the National Health Insurance Drug Price List
    • 7.2.6. Trends in Pricing and Reimbursement

8. Pharmaceutical Pricing and Reimbursement - Australia

  • 8.1. Macroeconomic Factors (PEST Analysis)
  • 8.2. Healthcare System in the Country
    • 8.2.1. Expenditure on Healthcare as a Percentage of GDP
    • 8.2.2. Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure
  • 8.3. Flow Chart for Flow of Funds in Australia
  • 8.4. Trends in Pricing and Reimbursement
    • 8.4.1. Remuneration Issues of Section 94 Private Hospitals
    • 8.4.2. Pharmacy Mark-Up Charts

9. Pharmaceutical Pricing and Reimbursement - Appendix

  • 9.1. Market Definitions
  • 9.2. Abbreviations
  • 9.3. Bibliography
  • 9.4. Research Methodology
  • 9.5. Healthcare System
  • 9.6. Pricing and Reimbursement Process
  • 9.7. Key Trends
  • 9.8. Contact Us
  • 9.9. Disclaimer

List of Tables

  • Table 1: Pharmaceutical Pricing and Reimbursement, Trend Analysis of Healthcare Expenditure Per Capita, ($), 2008-2010
  • Table 2: Pharmaceutical Pricing and Reimbursement, Public Health Expenditure as a Percentage of Total Health Expenditure, 2008-2010
  • Table 3: Pharmaceutical Pricing and Reimbursement, Out-of-Pocket Expenditure as a Percentage of Private Expenditure on Health, 2008-2010
  • Table 4: Pharmaceutical Pricing and Reimbursement, Healthy Life Years beyond the Age of 65 for Males and Females, 2010
  • Table 5: Pharmaceutical Pricing and Reimbursement, Healthcare Expenditure as a Percentage of GDP, The US, 2001-2010
  • Table 6: Pharmaceutical Pricing and Reimbursement, Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure, The US, 2001-2010
  • Table 7: Pharmaceutical Pricing and Reimbursement, Total Expenditure on Healthcare as a Percentage of GDP, The UK, 2001-2010
  • Table 8: Pharmaceutical Pricing and Reimbursement, Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure, The UK, 2001-2010
  • Table 9: Pharmaceutical Pricing and Reimbursement, The UK, General Price Changes (%), 2009-2013
  • Table 10: Pharmaceutical Pricing and Reimbursement, The UK, List of Treatments with Approved Patient Access Schemes, Recommended by National Institute for Clinical Excellence for Use in the National Healthcare Service, 2012
  • Table 11: Pharmaceutical Pricing and Reimbursement, List of Drugs Not to be Reimbursed from March 1, 2012, France
  • Table 12: Pharmaceutical Pricing and Reimbursement, Expenditure on Healthcare as a Percentage of GDP, France , 2001- 2010
  • Table 13: Pharmaceutical Pricing and Reimbursement, Private Expenditure and General Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure, France, 2001-2010
  • Table 14: Pharmaceutical Pricing and Reimbursement, Examples of Drugs Affected by Reimbursement Cuts, France, 2011
  • Table 15: Pharmaceutical Pricing and Reimbursement, Expenditure on Healthcare as a Percentage of GDP, Germany, 2001-2010
  • Table 16: Pharmaceutical Pricing and Reimbursement, Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure, Germany, 2001-2010
  • Table 17: Pharmaceutical Pricing and Reimbursement, Expenditure on Healthcare as a Percentage of GDP, Spain, 2001-2010
  • Table 18: Pharmaceutical Pricing and Reimbursement, Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure, Spain, 2001-2010
  • Table 19: Pharmaceutical Pricing and Reimbursement, Changes in Pharmaceutical Expenditure in 2012 from 2011 (%), Spain, 2011-2012
  • Table 20: Pharmaceutical Pricing and Reimbursement, Expenditure on Healthcare as a Percentage of GDP, Italy, 2001-2010
  • Table 21: Pharmaceutical Pricing and Reimbursement, Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure, Italy, 2001-2010
  • Table 22: Pharmaceutical Pricing and Reimbursement, List of Innovative Drugs for Regions, AIFA, Italy, 2010
  • Table 23: Pharmaceutical Pricing and Reimbursement, Total Expenditure on Healthcare as a Percentage of GDP, China, 2001-2010
  • Table 24: Pharmaceutical Pricing and Reimbursement, Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure, China, 2001-2010
  • Table 25: Pharmaceutical Pricing and Reimbursement, Total Expenditure on Healthcare as a Percentage of GDP, Japan, 2001-2010
  • Table 26: Pharmaceutical Pricing and Reimbursement, Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure, Japan, 2001-2010
  • Table 27: Pharmaceutical Pricing and Reimbursement, Expenditure on Healthcare as a Percentage of GDP, Australia, 2001-2010
  • Table 28: Pharmaceutical Pricing and Reimbursement, and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure, Australia, 2001-2010
  • Table 29: Pharmaceutical Pricing and Reimbursement, Pharmacy Mark-up Chart Comparison, Australia, 2012

List of Figures

  • Figure 1: Pharmaceutical Pricing and Reimbursement, Trend Analysis of Healthcare Expenditure Per Capita, ($), 2008-2010
  • Figure 2: Pharmaceutical Pricing and Reimbursement, Public Healthcare Expenditure as a Percentage of Total Healthcare Expenditure, 2008-2010
  • Figure 3: Pharmaceutical Pricing and Reimbursement, Out-of-Pocket Healthcare Expenditure as a Percentage of Private Expenditure on Healthcare, 2008-2010
  • Figure 4: Pharmaceutical Pricing and Reimbursement, Healthy Life Years beyond the Age of 65 for Males and Females, 2010
  • Figure 5: Pharmaceutical Pricing and Reimbursement, PEST Analysis, The US, 2012
  • Figure 6: Pharmaceutical Pricing and Reimbursement, Healthcare Expenditure as a Percentage of GDP, The US, 2001-2010
  • Figure 7: Pharmaceutical Pricing and Reimbursement, Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure, The US, 2001-2010
  • Figure 8: Pharmaceutical Pricing and Reimbursement, PEST Analysis, The UK, 2012
  • Figure 9: Pharmaceutical Pricing and Reimbursement, Total Expenditure on Healthcare as a Percentage of GDP, The UK, 2001-2010
  • Figure 10: Pharmaceutical Pricing and Reimbursement, Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure, The UK, 2001-2010
  • Figure 11: Pharmaceutical Pricing and Reimbursement, PEST Analysis, France, 2012
  • Figure 12: Pharmaceutical Pricing and Reimbursement, Expenditure on Healthcare as a Percentage of GDP, France, 2001-2010
  • Figure 13: Pharmaceutical Pricing and Reimbursement, Private Expenditure and General Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure, France, 2001-2010
  • Figure 14: Pharmaceutical Pricing and Reimbursement, PEST Analysis, Germany, 2012
  • Figure 15: Pharmaceutical Pricing and Reimbursement, Healthcare expenditure, ($) per inhabitant, Germany, 2011
  • Figure 16: Pharmaceutical Pricing and Reimbursement, Expenditure on Healthcare as a Percentage of GDP, Germany, 2001-2010
  • Figure 17: Pharmaceutical Pricing and Reimbursement, Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure, Germany, 2001-2010
  • Figure 18: Pharmaceutical Pricing and Reimbursement, PEST Analysis, Spain, 2012
  • Figure 19: Pharmaceutical Pricing and Reimbursement, Expenditure on Healthcare as a Percentage of GDP, Spain, 2001-2010
  • Figure 20: Pharmaceutical Pricing and Reimbursement, Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure, Spain, 2001-2010
  • Figure 21: Pharmaceutical Pricing and Reimbursement, PEST Analysis, Italy, 2012
  • Figure 22: Pharmaceutical Pricing and Reimbursement, Expenditure on Healthcare as a Percentage of GDP, Italy, 2001-2010
  • Figure 23: Pharmaceutical Pricing and Reimbursement, Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure, Italy, 2001-2010
  • Figure 24: Pharmaceutical Pricing and Reimbursement, PEST Analysis, China, 2012
  • Figure 25: Pharmaceutical Pricing and Reimbursement, Total Expenditure on Healthcare as a Percentage of GDP, China, 2001-2010
  • Figure 26: Pharmaceutical Pricing and Reimbursement, Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure, China, 2001-2010
  • Figure 27: Pharmaceutical Pricing and Reimbursement, PEST Analysis, Japan, 2012
  • Figure 28: Pharmaceutical Pricing and Reimbursement, Total Expenditure on Healthcare as a Percentage of GDP, Japan, 2001-2010
  • Figure 29: Pharmaceutical Pricing and Reimbursement, Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure, Japan, 2001-2010
  • Figure 30: Pharmaceutical Pricing and Reimbursement, Formula To Calculate New Drug Price, Japan, 2012
  • Figure 31: Pharmaceutical Pricing and Reimbursement, PEST Analysis, Australia, 2012
  • Figure 32: Pharmaceutical Pricing and Reimbursement, Expenditure on Healthcare as a Percentage of GDP, Australia, 2001-2010
  • Figure 33: Pharmaceutical Pricing and Reimbursement, Private and Government Expenditure on Healthcare as a Percentage of Total Healthcare Expenditure, Australia, 2001-2010
  • Figure 34: Pharmaceutical Pricing and Reimbursement, Flow of Funds, Australia, 2012
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