Pharma companies, brace yourselves for a more draconian
pricing environment. This outcome is inevitable in the mature markets of North
America, Western Europe, and Japan, upon which the international pharmaceutical
industry has long depended for sustained sales growth. With increasing
cost-containment pressures now stifling these markets, multinational
pharmaceutical companies are understandably exploring the potential of new
markets—notably, the fast-growing emerging markets (especially Brazil, Russia,
India, China, and Mexico). Even in these high-growth-potential markets,
however, governments are moving to contain costs. More than ever before,
commercial success will depend on securing the most favorable market access
conditions. Therefore, companies need to understand the challenges in each
country of bringing a new drug to market. This report provides a concise
overview of the essential elements of pharmaceutical pricing and reimbursement
in 14 markets across the globe. For each of these countries, we review the
provision of health insurance, pharmaceutical pricing, reimbursement, cost
containment, and health technology assessment. In addition, we assess the
international outlook and implications for the pharmaceutical industry.
Questions Answered in This Report:
Healthcare payers around the world vary enormously in their
approaches to pharmaceutical price setting. What are the key elements of the
pricing process in each market? Which markets are most liberal or most
restrictive with regard to pharmaceutical pricing? What impact does the pricing
process have on speed of market access? What
are the ramifications of recent initiatives, such as plans by the German and
U.K. governments to introduce value-based pricing?
Generous reimbursement is increasingly critical to a new drug’s
commercial prospects. Which bodies are responsible for making coverage
decisions? What factors are most influential in determining
reimbursement? What new strategies are manufacturers exploring to secure
reimbursement of costly drugs?
Payers in all markets are intensifying their efforts to contain
pharmaceutical costs. What are the most common approaches to
cost-containment? Which groups are the main targets of cost-cutting measures?
Demand for generic drugs is growing in all countries. How do
market trends vary by country? What are payers in mature markets doing to
promote greater use of generics? What role will generics play in the
development of emerging markets?
The use of health technology assessment (HTA) is on the
increase. Which markets already make extensive use of HTA and which are
beginning to adopt this discipline? What methods are commonly used? When do
reimbursement authorities generally conduct HTA? What are the prospects
for international collaboration? What are the implications of a prospective
overhaul of one of the world’s most influential HTA organizations?
For the foreseeable future,
emerging markets are likely to grow much faster than mature markets. What
demographic trends are evident in mature and emerging markets, and what impact
will that have on pharmaceutical companies? What challenges will
pharmaceutical companies face in mature markets? What are the main opportunities
and hazards in emerging markets?
Markets covered: United States, Canada, Mexico, Brazil,
France, Germany, Italy, Spain, United Kingdom, Russia, Japan, China, India,
Pharmaceutical pricing: general price-setting
procedures; renewal of pricing; pricing revisions.
Reimbursement: negotiation of reimbursement with
principal private and public health insurance programs.
Cost-containment: price cuts/freezes; sales growth
limits; reference pricing; waiver of copayments for low-priced drugs; maximum
reimbursement sums for some new drugs; mandatory rebates; voluntary rebates;
risk-sharing agreements; cost-sharing contracts; negative list; positive list;
dereimbursement of certain drugs; controls on detailing visits; prescribing
restrictions; prescribing budgets/audits; prescribing guidelines; prior
authorization; measures to promote generic prescribing; generics substitution;
therapeutic substitution; parallel imports; multitier formularies; copayments;
Health technology assessment (HTA): use of HTA in
reimbursement decision making; increasing use of health economic evaluation and
comparative effectiveness research.