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市場調查報告書
美國的特殊藥物：流通與償付型態的變化
Specialty Pharmaceuticals in the United States: Changing Patterns of Distribution and Reimbursement
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本報告已在2011年12月21日停止出版。
特殊藥物在醫療制度的藥物預算當中算是最昂貴的產品。因此相關利害關係人開始向商業保險業者及Medicare關心這些特殊藥物是如何提供，且如何被利用的。
專門於醫療產業相關廣泛調查的美國市調公司 Decision Resources Inc. （總公司：Massachusetts State），針對美國的特殊藥物進行調查分析，並系統整理調查結果後出版報告書 "Specialty Pharmaceuticals in the United States: Changing Patterns of Distribution and Reimbursement" 。
本報告書內容包括：1970年之後特殊藥物市場的變遷及市場中企業的購併趨勢、銷售企業提供的各種服務、醫療給付、藥物給付等醫療制度、今後對利害關係人產生的影響等。共計19頁的內容綱要摘記如下：
實施概要
序章
特殊藥物
特殊藥物的範圍
Medicare Competitive Acquisition Program
未來發展預測及對利害關係人產生的影響
表
- 主要特殊藥物企業的所有權
- Express Scripts的特殊藥物
圖
- 針對特殊藥物之民間保險制度的平均償付率：2004年秋季及2005年
- 各種處方制度中目標勞動人口的比例：2000年∼2006年
- 處方層級別需要患者自負以及／或者患者保險給付的勞動人口比例：2006年
- 非專利藥物、受歡迎的品牌藥物、不受歡迎的品牌藥物，以及第4級藥物的患者共同保險率變遷：2000年∼2006年
Abstract
Introduction
Specialty pharmaceuticals are among the most expensive products in health
plans’ pharmacy budgets. Thus, the provision and use of these drugs in
both the commercial insurance and Medicare arenas is of great interest to
several key stakeholders: specialty pharmacy vendors, payers, physicians,
patients, and drug manufacturers. These players will benefit from a buoyant
U.S. market for specialty drugs, which is set to grow vigorously for decades
to come.
Get the Answers Needed to Shape Your Strategy
Payers want their specialty pharmacy vendors to provide therapy or disease
management services. Will PBMs, wholesalers, and MCOs continue to make
acquisitions to establish a presence in this market? Can smaller companies
continue to thrive by carving out a niche for themselves in areas such as
specialized disease management?
Health plans are increasingly moving physician-administered specialty drugs
from the medical benefit to the pharmacy benefit. How will this move
improve health plans’ ability to implement cost-containment strategies?
How will it affect physicians’ prescribing powers?
The pharmaceutical and biotechnology companies that are developing
specialty drugs will need to adapt to a rapidly changing environment. How
can these companies shift their sales focus to address these changes? How can
they secure good formulary placement for their products?
The launch of new specialty treatments will likely increase payers’
bargaining powers; specialty drug classes that currently have little
competition could become more crowded. How will this competition affect
pricing of drugs? How will it affect manufacturers’ negotiations with
health plans (or their PBMs) on discounts or rebates?
Scope
- Evolution of specialty pharmacy: changes in the specialty pharmacy
market since its inception in the late 1970s; mergers and acquisitions in the
specialty pharmacy market.
- Services offered: a variety of services from specialty pharmacy
vendors.
- Commercial insurance: health plan coverage of specialty
pharmaceuticals as a medical benefit and a pharmacy benefit.
- Medicare: Medicare coverage of specialty pharmaceuticals under Part
B and Part D.
- Outlook and implications for stakeholders: outlook for specialty
pharmacy vendors, payers, physicians, patients, and drug manufacturers.
Mentioned in This Spectrum Report:
Companies
- Accredo Health
- AdvancePCS
- Aetna
- Aetna Specialty Pharmacy
- AmeriSource Bergen
- Aon Consulting
- Axium Healthcare Pharmacy
- BioScrip
- Caremark Rx
- Centocor
- Cigna
- CuraScript Pharmacy
- Curative Health Services
- CVS
- Dyckman & Associates
- Eckerds Specialty Pharmacy
- Express Scripts
- Genzyme
- Gilead
- Health Strategies Group
- Highmark
- IMS Health
- Kaiser Permanente
- McKesson
- McKesson Specialty
- Pharmacy
- Medco Health Solutions
- Medco Specialty Rx
- Medmark
- Novartis
- Option Care
- Pharmacare Specialty
- Pharmacy
- PrecisionRx
- Priority Healthcare
- Specialty Disease
- Management Services (SDM)
- Stadtlanders
- Tel-Drug
- UnitedHealth Group
- UnitedHealth Pharmaceutical
- Solutions
- United Therapeutics
- US Bioservices
- Walgreens
- Walgreens Specialty Services
- WellPoint/WellChoice
- Zitter Group
Organizations
- American Medical Directors
- Association
- American Society of
- Consultant Pharmacists
- Centers for Medicare and
- Medicaid Services (CMS)
- Health Research Educational
- Trust (HRET)
- Kaiser Family Foundation
- (KFF)
- Medicare Payment Advisory
- Commission (MedPAC)
- Pharmacy Care Management
- Association (PCMA)
Table of Contents
- Executive Summary
- Strategic Considerations
- Stakeholder Implications
- Introduction
- Specialty Pharmacy
- Evolution of Specialty Pharmacy
- Services Offered
- Coverage of Specialty Pharmaceuticals
- Commercial Insurance
- Medical Benefit
- Pharmacy Benefit
- Medicare
- The Medicare Competitive Acquisition Program
- Outlook and Implications for Stakeholders
Tables
- 1. Ownership of Leading Specialty Pharmacy Companies
- 2. Express Scripts’ Coverage of Specialty Drugs
Figures
- 1. Private Health Plans’ Average Reimbursement Rates for Specialty
Drugs, Fall 2004 and 2005
- 2. Percentage of Covered Workers in Formularies of Various Structures,
2000-2006
- 3. Percentage of Covered Workers Required to Pay Copayments and/or
Coinsurance by Formulary Tier, 2006
- 4. Evolution of Mean Patient Coinsurance Rates for Generics, Preferred
Branded Medicines, Nonpreferred Branded Medicines, and Fourth-Tier Drugs,
2000-2006
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