Healthcare Reform in the US - Impact on Pricing and Reimbursement

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					                      Healthcare Reform in the US - Impact on Pricing and
                                       Reimbursement
       Reference Code: GDHC0031VPT                                                                                                        Publication Date: April 2011


       1       Table of Contents                                                                   2    Summary
       1    Table of Contents............................................................. 1       On 23 March, 2010, the Obama administration brought into
       2    Summary ......................................................................... 1    effect the Patient Protection and Affordable Care Act (PPACA),
       3    Overview of Reforms ........................................................ 2         followed shortly by the Reconciliation Act of 2010 (H.R. 4872)
           3.1 Acts Overview............................................................ 2         on 30 March, both designed to overhaul the system of
       4    Main Aims of Reform ........................................................ 2         healthcare to address problems with access to medical help
           4.1 Medicare and Medicaid .............................................. 2
                                                                                                   and drug reimbursement. It is likely to be the most significant
           4.2 Coverage Extended to 32 Million Previously Uninsured
                US Citizens................................................................ 3      piece of legislation passed by the Obama administration, and
           4.3 Medicare Part D Reimbursement Gap......................... 3                        has far reaching consequences for patients, healthcare
       5    Impact on Pricing and Reimbursement.............................. 3                    professionals and industry alike. In total, the Congressional
           5.1 Effect on Insurance Premiums.................................... 3                  Budget Office (CBO) expects the bill to cost approximately $938
           5.2 Biologics to Benefit from Healthcare Reforms.............. 3                        billion, which should mean a reduction in the federal deficit of
           5.3 Impact of Closing the Reimbursement Gap in the
                                                                                                   around $138 billion over the next decade. However, this
                Medicare Part D Program........................................... 3
           5.4 Pharmaceutical Companies Forced to Make                                             calculation is a point of contention between different groups.
                Concessions on Pricing and Rebates.......................... 4                     The PPACA has faced severe criticism from the Republican
           5.5 Increased Patient Population Benefits Pharmaceutical
                                                                                                   Party and special interest groups, and compromises may need
                Industry ..................................................................... 4
       6    Overall Effect on Market ................................................... 4         to be made regarding alterations to the acts in order to ensure
       7    Appendix.......................................................................... 4   that they can function. Legal challenges as to the
           7.1 Methodology .............................................................. 4        constitutionality of the bill have also been made. Despite a clear
             7.1.1    Coverage .......................................................... 4        timeline for the implementation of different parts of the reforms,
             7.1.2    Secondary Research ......................................... 4               problems are expected in several areas. Negotiation is ongoing
             7.1.3    Primary Research.............................................. 5             between the different political groups to form a system that is
             7.1.4    Expert Panel Validation ..................................... 5
                                                                                                   workable in the US.
           7.2 Contact Us................................................................. 5
           7.3 Disclaimer.................................................................. 5      The pharmaceutical industry has naturally been concerned
                                                                                                   about the introduction of healthcare reform and the possible
                                                                                                   impact it may have on their revenues. As a result, various large
                                                                                                   pharmaceutical companies have been negotiating with the
                                                                                                   government, recognizing that in order to remain successful
                                                                                                   under the new system they must make sacrifices in some areas
                                                                                                   in terms of pricing. To this end, concessions in areas such as
                                                                                                   closing the reimbursement gap in the Medicare Part D plan
                                                                                                   have been made. There are positives and negatives for the
                                                                                                   industry under the reforms.
                                                                                                   Prior to the introduction of the healthcare reforms, the US
                                                                                                   healthcare system had suffered serious problems in terms of
                                                                                                   access to medical care and drug pricing and reimbursement. To
                                                                                                   what extent the new bills will be able to successfully address
                                                                                                   these is as yet unclear. In 2009, before the reforms were
                                                                                                   brought in, the US Census Bureau recorded that 16.7% of US
                                                                                                   residents did not have medical insurance (equating to about 50
                                                                                                   million people), and a Harvard study estimated that this caused
                                                                                                   almost 45,000 excess deaths a year in the country. In addition,
                                                                                                   US healthcare
				
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Description: Healthcare Reform in the US - Impact on Pricing and Reimbursement Summary On 23 March, 2010, the Obama administration brought into effect the Patient Protection and Affordable Care Act (PPACA), followed shortly by the Reconciliation Act of 2010 (H.R. 4872) on 30 March, both designed to overhaul the system of healthcare to address problems with access to medical help and drug reimbursement. It is likely to be the most significant piece of legislation passed by the Obama administration, and has far reaching consequences for patients, healthcare professionals and industry alike. In total, the Congressional Budget Office (CBO) expects the bill to cost approximately $938 billion, which should mean a reduction in the federal deficit of around $138 billion over the next decade. However, this calculation is a point of contention between different groups. Scope - The pharmaceutical industry has naturally been concerned about the introduction of healthcare reform and the possible impact it may have on their revenues. As a result, various large pharmaceutical companies have been negotiating with the government, recognizing that in order to remain successful under the new system they must make sacrifices in some areas in terms of pricing. To this end, concessions in areas such as closing the reimbursement gap in the Medicare Part D plan have been made. There are positives and negatives for the industry under the reforms. Reasons to buy - Gives impact analysis of Pricing and Reimbursement due to Healthcare Reform in the US
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