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市場調查報告書

藥價及給付的革新:保險者的展望 (2016年)

Innovations in Drug Pricing and Reimbursement (2016)

出版商 FirstWord 商品編碼 353280
出版日期 內容資訊 英文
商品交期: 最快1-2個工作天內
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藥價及給付的革新:保險者的展望 (2016年) Innovations in Drug Pricing and Reimbursement (2016)
出版日期: 2016年02月01日 內容資訊: 英文
簡介

在藥價設定中醫藥品產業日趨嚴苛,慢性疾病的新藥價格正在大幅度上升中,市民,醫療提供者,行政,保險者間的對立也正在全球性擴大。

本報告由以美國·歐洲的保險者為對象所進行採訪結果,彙整保險者對這些狀況的處理、及制止醫療費高漲的各種策略等相關之見解·考察。

主要的調查項目

  • fundamental的影響因素
    • 醫藥品產業在罕見疾病及高價格生物製藥的投入,為何會是對保險者而言的問題,又是多大的問題?
  • Wild West的臨終?
    • Medicare的藥價談判權和以削減醫療費為目標利用競爭壓力的PBM僅是美國藥價管理對策的一小部分:其它還有什麼樣的對策是討論的對象?有什麼樣極端的案例?
  • 歐洲的多樣性
    • 參考價格·價格數量協定·競標·早期效用評估·HTA成本效益分析與風險共享·整體系統產品價值:全部採用,但在什麼地方,有達到何種效果?
  • 相關利益者的買入
    • 醫藥產業與保險者的初期開放式對話框:為何?以及要如何成為雙方的優勢?
  • 正面訊息?
    • 醫藥產業的社會成本效益性訊息為何難以傳達?為了得到支援可做些什麼?
  • 「不變的話」
    • 在一定的利益前,是否需要重新評估為了供給革新與開發的資金而將藥品高價正當化的醫藥產業說明?
  • 風險分擔環
    • 基於風險分擔環·價值的藥價估計(VBP:Value-based Pricing)·適應症跟藥價設定:是否是今後的最佳方案?
  • 地區的市場·地區的問題
    • 各國致力於獨自的醫療費削減手法,但彼此吸取的經驗是什麼?藥價設定已經不是一國的問題而是地區性問題了嗎?
目錄
Product Code: 596200484

Drug costs are becoming unaffordable and draconian cost containment strategies are being employed.

The pharma industry is winning few friends when it comes to drug pricing. Public, health professional, political and payer hostility is growing worldwide as the prices of new drugs for chronic disease, specialty medicines and even generics grow excessively. How are payers in the US and Europe responding and what cost containment strategies are being - and could be - employed to cap rampant and increasingly unaffordable drug bills?

Drug Pricing: Health payers gear up for battle is ahard-hitting reportwhich reveals what US and European health payers are really thinking and planning. Often blunt, and always incisive, this report contains valuable and clear lessons for industry - and lessons they should learn well.

“It's pretty discouraging, unfortunately. It makes you think these companies are not really involved in healthcare. I don't think they are...They just are profit centres.” US Payer.

Answering key questions:

  • A Fundamental Driver: Why, and to what extent, is the pharma industry's focus on orphan diseases and high-end biologics creating such an issue for payers?
  • The End of the Wild West? Freeing Medicare to negotiate drug pricing and PBMs utlilising competitive pressures to lower costs are just some of the solutions to controlling US drug prices- what else is on the table and how extreme might regulators get?
  • European Variance: Reference pricing, price-volume agreements, tendering, early benefit assessments, HTA cost/benefits assessments, risk-sharing and whole system product value are all being employed - but where and with what success?
  • Stakeholder Buy-In: Why, and how, might early and open dialogue between industry and payers benefit both parties?
  • Positive Message? Why is industry failing to get its societal and cost-benefit message heard, and what more could it do to win support?
  • Same Old, Same Old: In the face of solid profits does industry's narrative of justifying high drug prices to fund innovation and development need an overhaul?
  • Risk Sharing: Are risk-sharing, value-based pricing and pricing by indication the best schemes moving forward?
  • Local Market, Local Problems: Each country has gone its own way in controlling cost - what could they learn from each other and is drug pricing now a regional rather than just a national issue?

With this report you will be able to:

  • Understand the fundamental research trends that are driving payer concerns and disquiet
  • Learn which reimbursement strategies are being employed
  • Assess the multi-country alliances that are forming to negotiate better prices
  • Appreciate how cost-containment measures vary from country to country
  • Understand why and how cost containment measures are likely to intensify
  • Address the pressing need for companies to explain their pricing policies better and support brands with outcomes evidence
  • Know what payers want and formulate better communication strategiesin healthcare. I don't think they are...They just are profit centres.” US Payer

Key Topics explored

  • Is the pharma industry digging its own grave? Price increases above and beyond any economic indicator, price gouging and products which bring little clinical advantage but big cost are creating much ill will and leading to wider and more severe cost containment policies.
  • Cash strapped payers cannot afford to meet all the demands of aging populations - how can industry positively respond to these concerns?
  • Even the hitherto free market of the US is now actively seeking ways to control cost. Moves to liberate the negotiating hand of Medicare and a range of other control measures will limit the industry's scope to act. How far could these developments go?
  • European countries share the same problems but each has taken a different approach - will consensus emerge and what are the key market variables that pharma should know about?
  • Drug intervention plays a critical role in controlling disease. Effective medicines and good adherence can improve the patient's quality of life and significantly reduce overall health expenditure. But these benefits often go unrecognised. Is there a communication issue pharma needs to address?
  • Biosimilars hold the prospect of lower prices for biologics, but will this sector ever really gain traction in the market?

Expert Contributors

The report is informed through in-depth interviews with payers responsible for drug budgets in the US and EU5 leading economies. To ensure open and critical responses all contributors are anonymous but include:

  • Pharmacy director at US-based pharmacy-benefit management organisation
  • Chief pharmacist at NHS Foundation Trust in England
  • Drug-reimbursement manager for German health insurers
  • Head of pharmacy at French university hospital
  • Advisor to Spanish hospitals on pharmacoeconomics and formulary inclusion of new medicines
  • Director, department of clinical pharmacy in Italy
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