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市場調査レポート
支払者、医療提供者および患者が医薬品市場に及ぼす影響の拡大
The Increasing Influence of Payers, Providers, and Patients on the U.S. Pharmaceutical Market
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当商品の販売は、2011年12月21日を持ちまして終了しました。
Abstract
Introduction
Pharmaceutical manufacturers must contend with the often-confl icting
requirements of three principal customer groups: payers, providers, and
patients. Health plans and pharmacy benefit management companies (PBMs)
maintain enormous infl uence over consumers' health care choices through their
control of formularies and reimbursement restrictions. However, formulary
designs are rapidly changing, and reimbursement restrictions are being used
more frequently. And although physicians remain the ultimate decision makers
regarding which medications patients receive, some traditional methods that
drug manufacturers have used to access physicians are becoming increasingly
difficult to employ. Meanwhile, the spread of "consumerism" has begun to shift
responsibility for health care to patients-who may not be willing to spend as
much money on drugs in a brave new world that features consumer-driven health
plans (CDHPs) and 24/7 access to health care information via the Internet.
Reconciling the demands of all three groups is likely to prove more difficult
for drug manufacturers in the future.
Get the Answers You Need to Shape Your Strategy
- Cost-containment measures are proliferating within the reimbursement plans
of managed care organizations (MCOs) and PBMs. What are the most popular
cost-containment measures? Why might some costcontainment measures
backfire?
- Faced with growing numbers of drugs and increasing costs, the pharmacy and
therapeutics (P&T) committees that decide the composition of formularies for
MCOs and PBMs are becoming increasingly demanding of drug manufacturers.
What information are P&T committees specifi cally requesting from
manufacturers so that these committees can evaluate the overall value of
manufacturers' products?
- More than three-quarters of P&T committees regard drug acquisition costs
as the predominant factor in formulary and reimbursement decisions. However,
the vast majority of P&T committees are prepared to give preferred formulary
status to certain new drugs that are in fact more expensive than current
formulary drugs. Under what circumstances are P&T committees likely to
grant preferred status to more expensive drugs?
- Spending by pharmaceutical companies on physician detailing has recently
declined, which may refl ect growing resistance to this type of promotional
practice in the medical community. What barriers do manufacturers
increasingly have to overcome to maintain their detailing activities?
- In recent years, the role of "consumerism" in U.S. health care has
attracted considerable attention and introduced the creation of
consumer-driven health plans (CDHPs). Why might the spread of CDHPs be bad
news for drug manufacturers?
Scope
- Payers: new designs for MCO and PBM formularies; the use of rebates
and discounts; the proliferation of cost-containment measures.
- Providers: changes in the use of physician detailing, professional
advertising, and sampling.
- Patients: increased direct-to-consumer advertising; the rise of
"consumerism"; the establishment of health-savings accounts and CDHPs; the
infl uence of the Internet.
- Outlook and implications: the reimbursement environment; the
increasing role of generics; new criteria for formularies; the use of health
technology assessment and health economic evaluation; increasing consumer
emphasis on disease prevention and wellness programs; the role of CDHPs; the
infl uence of health-related Web sites.
Table of Contents
- Executive Summary
- Strategic Considerations
- Stakeholder Implications
- Introduction
- Payers
- Formulary Negotiations
- Rebates and Discounts
- Increasing Cost Containment
- Multitier Formularies
- Patient Copayments and Coinsurance
- Use of Generics
- Prior Authorization and Step Therapy
- Providers
- Physician Detailing
- Professional Advertising
- Sampling
- Patients
- Direct-to-Consumer Advertising
- The Internet
- The Rise of Consumerism
- Outlook and Implications for the Pharmaceutical Industry
Sidebars
- A New Generation of Health Web Sites
- Encouraging Consumers to Take More Responsibility for Their Health Care
Tables
- 1. Frequency of Select Situations in Formulary Decision-Making
- 2. Importance of Select Factors in Managed Care Organizations' Formulary
Decision-Making
- 3. U.S. Employers' Views Regarding Strategies to Increase Prescription
Drug Benefit Value, 2005
- 4. Pros and Cons of Direct-to-Consumer Advertising
- 5. Key Features of Health Savings Accounts and Health Reimbursement
Accounts
Figures
- 1. Managed Care Organizations' Desired Changes in Pharmacoeconomics
- 2. Mean Patient Copayments for Generics, Preferred Branded Medicines,
Nonpreferred Branded Medicines, and Fourth-Tier Drugs, 2000-2006
- 3. Percentage of Covered Workers Required to Pay Copayments and/or
Coinsurance, by Formulary Tier, 2006
- 4. Mean Patient Coinsurance Rates for Generics, Preferred Branded
Medicines, Nonpreferred Branded Medicines, and Fourth-Tier Drugs, 2000-2006
- 5. Total U.S. Spending on Select Forms of Pharmaceutical Promotional
Activity, 2002-2006
- 6. Percentage of Employers Offering Their Employees the Option of
Enrollment in a Consumer-Directed Health Plan, 2004-2008 (projected)
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