US Pricing and Reimbursement
US Pricing and Reimbursement
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Historically, few pricing controls have been implemented in the US; however, there is greater pressure to implement controls to help contain costs associated with the expansion of public healthcare provision.
Publisher: Datamonitor Healthcare
- Description
- Contents
- Samples
- Historically, few pricing controls have been implemented in the US; however, there is greater pressure to implement controls to help contain costs associated with the expansion of public healthcare provision.
- Increasingly restrictive formularies and higher cost sharing by patients are used as a reimbursement tool to control medication utilization.
- Increased support for comparative effectiveness research brought about by the healthcare reform is reflecting global trends and is paving the way for the use of cost-effectiveness analysis in the more distant future.
TABLE OF CONTENTS
4 EXECUTIVE SUMMARY
4 Pricing in the US
4 Reimbursement in the US
6 OVERVIEW OF PRICING AND REIMBURSEMENT IN THE US
6 US drug prices are among the highest in the world
6 A wide range of primarily reimbursement-focused controls are used to contain costs
8 PRICING REGULATIONS IN THE US PHARMACEUTICAL MARKET
8 Few pharmaceutical pricing controls are used in the US; however, there is pressure to use
more
10 A number of rebates, discounts, and subsidies have been introduced as part of the ACA
11 Private sector rebates have been controversial but the ACA may increase transparency
13 REIMBURSEMENT REGULATIONS IN THE US PHARMACEUTICAL MARKET
13 Tools restricting reimbursement for costly new drugs continue to be popular and widely used
24 The move towards comparative effectiveness and the crawl towards cost-effectiveness analysis
in the US
29 BIBLIOGRAPHY
LIST OF FIGURES
10 Figure 1: Different pricing is used at different stages of the supply chain
14 Figure 2: Of the 15.2% negative impact on US pharma market growth in 2015, formulary
pressure is the biggest contributor to the loss in sales
15 Figure 3: The increase in tier number in employer-sponsored health plans, 2000–12
18 Figure 4: Increased focus on prior authorization by health plans going forward
19 Figure 5: Tools that large employers are set to use in 2013
20 Figure 6: PAP popularity in a survey of oncology practices, 2009
23 Figure 7: Drug companies and US payers have similar views on the effectiveness of risk
sharing
24 Figure 8: Rise in HSA-qualified high-deductible health plan enrollment, 2006–12
LIST OF TABLES
6 Table 1: Range of pricing and reimbursement tools used in the US
Table 1: Range of pricing and reimbursement tools used in the US
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