The Payer Landscape in the United States - The Pharmaceutical Industry Faces a Rapidly Changing Marketplace

The Payer Landscape in the United States - The Pharmaceutical Industry Faces a Rapidly Changing Marketplace

Summary

Managed care began to be developed as early as 1917, with both private and government payers established by the mid-1960s. Medicare and Medicaid are the major government payers, with the health care reform legislation of 2010 providing changes for both. That said, private payers, such as regionals, nationals and blues plans, may take the brunt of the reform policies put in place.

The health care reform legislation in 2010 was the product of extended debate and compromise. The legislation will mean huge changes for the insurance industry if it is enacted. However, the more controversial aspects of the legislation, particularly the Mandate for health insurance, have resulted in numerous challenges.

For pharmaceutical companies, there are potential gains and challenges. Much of the 2010 health care reform legislation is very positive for the industry. If the Supreme Court ruling or the November elections mean that all or much of the legislation is scrapped, then the industry will again have to spend millions of dolloars in lobbying to ensure similar gains in whatever legislation takes its place. Working with payers will also provide the industry with challenges of increased pressure for generics, but may provide opportunities for pharmas to further their relationships with providers.

The report, “The Payer Landscape in the United States - The Pharmaceutical Industry Faces a Rapidly Changing Marketplace”, was written to support pharmaceutical companies with their strategic plans to grow their businesses and prepare for future challenges they’ll soon face within the changing health care playing field.

Scope

- Development of payers in the US including history of payers, types of payers
- Details on government payers - Medicare and Medicaid and top private payers
- Health Care Reform and payers – 2010 legislation
- Payer Response to health care reform – changing the business model
- Payers and generics – growth of the generics market
- The Outlook for payers and pharmaceutical companies – new revenue streams

Reasons to buy

- Understand the changes taking place within the payer landscape and its impact on the pharmaceutical industry
- Look forward to what health care reform will mean to providers relationship with payers
- Assess the potential for biosimilar use by payers given the recent rules outlined by the FDA
- Gain a clearer understanding of providers’ views on the payers that they work with
- Assess the impact that the current health care landscape has on how the pharmaceutical industry works with payers, as well as how it could change based on the upcoming Supreme Court rulings and elections

Executive Summary

Development of Payers in the US
History of payers
Types of payers
Government Payers
Medicare
Medicaid
Top Private Payers

Health Care Reform and Payers
2010 legislation
Current challenges

Payer Response to Health Care Reform
Changing the business model
New focus on outcomes
Cost-saving measures

Payers and Generics
Growth of the generics market
The outlook for biosimilars
Payer response – a look at Lipitor

The Outlook for Payers and Pharmaceutical Companies
New revenue streams
State exchanges
Supreme Court ruling
Presidential election
De-coupling
Impact on pharmaceutical companies

Appendix