A Guide to Drug Pricing and Reimbursement
Drug pricing is one of the key levers that determine the profitability of a drug company. Premium pricing of a new drug helps cover the high cost of innovation and helps run a profitable enterprise. But the recent onslaught of generics, as well as shrinking government and corporate healthcare budgets, is threatening the time-tested models, leading to higher pricing pressures for pharmaceutical and biotech companies in the coming years. In this environment, executives in these companies and the consultants who service them need better information to make the most profitable decisions.
A Guide to Drug Pricing and Reimbursement provides considerable detail on the this all-important area of pharmaceutical marketing strategy. The guide describes pricing strategies for specific results, including:
- Gaining Market Share
- Defending Market Share
- Enhancing Brand Loyalty
- Gaining New Customers
- Improving Margins
- Utilizing Capacity
The result of exhaustive research into recent pricing trends as well as interviews with top pharmaceutical executives, the Guide provides executives in pricing decision capacities with critical information needed to arrive at the most effective strategy:
- Useful statistics detailing the Overall Pharmaceutical Pricing Environment, including Healthcare Expenditures, Pharmaceutical Expenditures and Drug Prices in Select Countries as well as Biopharmaceutical R&D Expenditures
- Updated Medicare Reimbursement Information for Parts A,B,C and D
- The Development phases in which it is most important to consider pricing
- Overview of U.S. Pharmaceutical Market (including Healthcare Spending, Promotional Spending, Average Co Payments, Generic Drug Trends, Single Source Brand Vs. AWP and more.)
- Pricing Strategies for the European Market
- Japanese Market Pricing and Reimbursement Strategies.
Drug pricing and reimbursement also differs widely across the globe due to the huge disparity in economic situations of various countries, and this global report addresses the pricing environments in:
- U.S
- Europe
- Japan
Pricing and reimbursement will remain one of the most talked about industry issues going into the next decade. This report aims to provide a holistic view on pricing and reimbursement across the globe. This report enables executives to make proactive decisions and to craft their responses to the changing dynamics of the market.
Table of Contents
- Executive Summary
- Drug Pricing and Reimbursement: Strategic Overview
- Factors affecting Pharmaceutical Expenditur
- Key Issues and Challenges
- Pricing Strategies
- Regional Pricing Differences
- Scope and Methodology
- Reasons for Conducting the Study
- 2.1. Background
- 2.2. Global healthcare costs and their Impact on GDP
- 2.3. Drug Costs and Affordability
- 2.3.1. Price Variability across countries
- 2.4. Factors contributing to Drug Expenditures
- a) Volume Growth
- b) Rising Prices
- 2.5. Pharmaceutical Pricing and Ethics
- 2.5.1. Differential Pricing
- 2.5.2. HIV/AIDS Pricing & Ethics
- 3.2. Pricing Strategies: Goals
- 3.2.1. Market Share
- 3.2.2. Defending Market share
- 3.2.3. New Customers
- 3.2.4. Enhancing Brand Loyalty
- 3.2.5. Improving Margins
- 3.2.6. Capacity Utilization
- 3.3. Pricing Decisions: Types
- 3.3.1. Traditional Pricing
- 3.4. Role of Pricing Function in Price setting
- 3.5. Pricing and Pharmacoeconomics
- 3.6. Price Optimization
- 3.7. Pricing in the Product Development Process
- 3.7.1. Background
- 3.7.2. The First Price Estimate
- 3.7.3. Improving Pricing in the Product Development Process
- 4.1.1. National Prescription Drug Expenditures
- 4.1.2 Pharmaceutical Costs
- 4.1.2.3. Factors for rise in pharmaceutical costs
- 4.1.3. Future trends in Pharmaceutical Costs
- 4.1.3.2. Increased Generic Penetration
- 4.1.3.2. Rising Consumerism
- 4.1.3.4. Shifting Payor Mix
- 4.1.3.5. Cost Containment and the Formulary
- 4.1.3.6. Basis of price determination
- 4.3. Price Movement
- 4.3.1 Impact of Supply Chain on Price
- 4.3.2. Supply chain and price differentials
- Retail Sector
- Non retail sector
- 4.4. Key Pricing measures
- 4.4.1. Background
- a) Average Manufacturer’s Price (AMP)
- b) Average Sales Price (ASP)
- c) Average Wholesale Price (AWP)
- d) Estimated Acquisition Cost (EAC)
- e) Federal Supply Schedule.
- f) Federal Upper Limit (FUL)
- g) Maximum Allowable Cost (MAC)
- h) Wholesale Acquisition Cost (WAC)
- 4.5. Drug Pricing Litigations
- 4.6. Pricing Dynamics
- Single-Source Drugs
- Multiple-Source Drugs
- 4.7. Pricing and customer segments
- 4.7.1 Background
- 4.7.2 Pharmacy Benefit Managers
- Background
- PBM role
- Cost containment Strategies
- Pharmacies
- PBMs’ Negotiated Payments to Pharmacies
- PBMs’ Payments to Pharmacies
- 4.7.4. Cash Customers
- 4.7.5. Government Markets
- 4.7.5.1. Federal Supply Schedule
- 4.7.5.2. 340B Drug Discount Program
- 4.7.5.3. Medicare
- a) PART A
- b) PART B
- Medicare Reimbursements
- c) Part C (Medicare Advantage)
- d) PART D
- Future Challenges
- 2008 Changes in Medicare Part D Payments
- Calculation of the Low-Income Benchmark Premium Amounts
- Annual Updates to Medicare Part D Benefit Parameters
- 4.7.5.4. Medicaid
- 4.7.6. Third party payors
- Managed care business structure
- Healthcare maintenance organizations (HMO)
- Point of service (PoS)
- Preferred provider organizations (PPO)
- MCOs and Pharmacy Benefit Managers (PBMs) relationships
- Co-payments and cost-reduction initiatives
- Managed Care Contracting: Pharmaceutical Manufacturers’ Perspective
- Managed Care Business Goals
- Managed Care Strategy
- 6. Monitoring Performance
- 4.7.7. Emerging Issues
- 4.7.7.1.Drug Price Transparency in United States
- 4.7.7.2. Wal-Mart and $4 Generics
- 4.7.7.3. Average Wholesale Price and First Data Bank
- 5.1.1 EU Pricing Environment
- 5.1.2. Reimbursement Mechanisms
- 5.1.3. Pricing and Reimbursement impact on new product launch sequence
- 5.1.4. Drug Budgets
- 5.1.5. Pricing and Reimbursement Overview
- U.K. and Germany
- France, Italy and Spain
- 5.1.6. Parallel Trade
- Germany
- 5.2.1. Background
- 5.2.2. Statutory Health Insurance Funds
- 5.2.2.1.Reference Prices
- 5.2.3. Statutory Health Insurance Market
- FRANCE
- 5.3.1. Background
- 5.3.2. Regulatory Affairs in France
- 5.3.3. Regulations
- UK
- 5.4.1.Pricing System
- 5.4.2. Pricing of New Products
- 5.4.3. Pricing Methods for Generic Products
- 5.4.4. Reimbursement
- ITALY
- 5.5.1. Pricing Systems
- 5.5.2. Reimbursement
- SPAIN
- 5.6.1. Pricing Systems
- 5.6.2. Reference Pricing System
- 5.7.Tackling Parallel Trade
- 6.2. Japanese Healthcare System
- Employee’s Health Insurance Plan
- National Public Health Insurance Plan
- 6.2. Bungyo
- 6.3. Reimbursement system
- 6.3. The R-Zone and regular price decreases
- 3.1. Background
- 4.1.U.S. Healthcare Expenditures
- 5.1. Background
- 6.1. Background
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