市場調査レポート

米国政府の医薬品償還:成功する重要な処方薬ポジショニングおよび価格管理

US Government Drug Reimbursement: Winning Key Formulary Positions and Managing Pricing Systems

発行 Cutting Edge Information 商品コード 320273
出版日 ページ情報 英文 55 Pages
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米国政府の医薬品償還:成功する重要な処方薬ポジショニングおよび価格管理 US Government Drug Reimbursement: Winning Key Formulary Positions and Managing Pricing Systems
出版日: 2014年11月30日 ページ情報: 英文 55 Pages
概要

当レポートでは、ライフサイエンス企業における米国政府医療費償還関連業務の管理方法について分析し、製品ライフサイクル全体のベストプラクティスに光をあてた、製薬企業のエグゼクティブとそのアドバイザーによる議論をまとめ、お届けいたします。

エグゼクティブサマリー

  • 調査定義
  • 米国政府保険者の管理:成功のための3つの提言

米国政府保険者によって最適の処方薬ポジショニングを獲得する

  • 意思決定者が常に情報に精通しているよう、政府保険者と継続的な契約を成立させる
  • 政府保険者の期待を予測する

米国政府の医療費償還をより良くナビゲートするための明白な価格プロセスの実行

  • 一貫性した政府医療費償還戦略を促進するため複数の機能の取り込み
  • 特定のメトリクスを用いた医療費償還手順の成立

構造、予算配分およびアウトソーシングによる政府の医療費償還能力の拡大

  • 内部コーディネーション・コミュニケーションを改善するため、医療費償還チームを構成する
  • 政府の医療費償還予算配分のためのベンチマーク・ガイドライン
  • 医療費償還モデルを構築しコンプライアンスを保証するため、ベンダーを採用する
目次
Product Code: PH204

Life science companies navigating US government payers' complex guidelines for reimbursement have found their tasks increasingly intricate. New guidelines brought in under the Affordable Care Act have only added to this burden. As Medicaid at the state level transitions to managed care on a larger scale, companies must react by tailoring their approach to meet those payers' specific needs.

This report provides insight into how companies are managing their operations in relation to US government reimbursement. In-depth discussions with pharmaceutical company executives and their advisors shed light on best practices throughout the product lifecycle.

CHAPTER OUTLINES

CHAPTER - 1

This chapter discusses how companies work with payers to position their products appropriately on formularies. Discussions with payers at an early stage of product development are crucial. Other key components of a government payer strategy are making sure that meetings are of a suitable length and contain information targeted to payer needs. To collect and present these data successfully, it is important that managed markets, medical affairs and clinical groups within the company coordinate responsibilities smoothly.

CHAPTER - 2

Amid the growing influence of the Affordable Care Act, government reimbursement continues to be a hot topic. Even before a company launches a new product, teams must determine what steps are necessary to secure support from federal and state reimbursement agencies. In some cases, this may require regional specialization. In others, teams may reach out to physicians and other healthcare consumers to gather product support prior to market availability. Chapter 2 focuses on the teams involved and the metrics used within companies' pricing processes. This chapter also addresses the reimbursement challenges associated with defining fair market value.

CHAPTER - 3

This chapter shows how teams structure government reimbursement operations and spend budgets. Government reimbursement team structures often vary by company size, but how teams operate depends on the number of products that generate a significant amount of revenue through government reimbursement. Regardless of team structure, most surveyed companies allocate their spending so that the majority goes to account manager compensation. Finally, outsourcing is a common practice among government reimbursement teams - especially for third-party compliance audits.

SAMPLE

Figure E.1:
Primary Function Communicating with US Government Payers

Table of Contents

Executive Summary

  • Study Definitions
  • Managing US Government Payers: Three Recommendations for Success

Gaining Optimal Formulary Position with US Government Payers

  • Establish Constant Contact with Government Payers Often to Keep Decision Makers Informed
  • Anticipate Government Payers' Expectations

Implementing Clear Pricing Processes to Better Navigate US Government Reimbursement

  • Involve Multiple Functions to Promote Consistent Government Reimbursement Strategy
  • Establish Reimbursement Procedures Using Specific Metrics

Expanding Government Reimbursement Capabilities through Structure, Budget Allocation and Outsourcing

  • Structuring Reimbursement Teams to Improve Internal Coordination and Communication
  • Benchmarks and Guidelines for Allocating Government Reimbursement Budgets
  • Employing Vendors to Build Reimbursement Models and Ensure Compliance

Executive Summary

Managing US Government Payers: Three Recommendations for Success

  • Figure E.1: Primary Function Communicating with US Government Payers

Gaining Optimal Formulary Position with US Government Payers

  • Figure 1.1: Overview: Meeting with US Government Payers
  • Figure 1.2: Phase During Which Companies Begin Meeting with US Government Payers

Establish Constant Contact with Government Payers Often to Keep Decision Makers Informed

  • Figure 1.3: Duration of Meetings with US Government Payers, by Phase
  • Figure 1.4: Duration and Number of Meetings with US Government Payers: Phase 3
  • Figure 1.5: Duration and Number of Meetings with US Government Payers: Registration and Launch
  • Figure 1.6: Primary Function Communicating with US Government Payers
  • Figure 1.7: Functions Involved in Getting a Product on the Formulary: Top 50 Companies
  • Figure 1.8: Functions Involved in Getting a Product on the Formulary: Small Companies

Implementing Clear Pricing Processes to Better Navigate US Government Reimbursement

  • Figure 2.1: US Government Reimbursement Process at a Glance

Involve Multiple Functions to Promote Consistent Government Reimbursement Strategy

  • Figure 2.2: Functions Involved in the US Government Reimbursement Process: Top 50 Companies
  • Figure 2.3: Functions Involved in the US Government Reimbursement Process: Small Companies
  • Figure 2.4: US Government Reimbursement Team Structure: Sample Structure A

Establish Reimbursement Procedures Using Specific Metrics

  • Figure 2.5: Functions Involved in Calculating BP and AMP Data
  • Figure 2.6: Functions Involved in Submitting BP and AMP Data to CMS
  • Figure 2.7: Functions Involved in Calculating Quarterly Rebate
  • Figure 2.8: Price Tracking Strategy, by Company
  • Figure 2.9: Companies' Perception of US Government Payers' Strategic Importance to Reimbursement, by Payer Type

Expanding Government Reimbursement Capabilities through Structure, Budget Allocation and Outsourcing

  • Figure 3.1: Overview: US Government Reimbursement Structure, Budget Allocation and Outsourcing

Structuring Reimbursement Teams to Improve Internal Coordination and Communication

  • Figure 3.2: Ways in Which Companies Organize Their US Government Reimbursement Teams
  • Figure 3.3: Ways in Which Companies Organize Their US Government Reimbursement Teams: Top 50 and Small Companies
  • Figure 3.4: US Government Reimbursement Team Structure Depends on Company Size
  • Figure 3.5: Percentage of Centralized US Government Reimbursement Teams Reporting to a Larger Group
  • Figure 3.6: Team Operation Depends on Exposure to US Government Reimbursement
  • Figure 3.7: Percentage of Companies with a Dedicated Contracts and Pricing Committee
  • Figure 3.8: Annual Spending for US Government Reimbursement (2012-2014), by Company

Benchmarks and Guidelines for Allocating Government Reimbursement Budgets

  • Figure 3.9: Average Percentage Breakdown of US Government Reimbursement Budget Allocations: All Companies
  • Figure 3.10: US Government Reimbursement Budget Allocation: Top 50 Companies
  • Figure 3.11: US Government Reimbursement Budget Allocation: Small Companies

Employing Vendors to Build Reimbursement Models and Ensure Compliance

  • Figure 3.12: Percentage of US Government Reimbursement Budget and Activities Outsourced
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