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Pricing & Reimbursement in Emerging Markets: Analysis of pricing mechanisms and the influence of public and private sector health insurance provision

Over the past few years, pharmaceutical sales in the emerging markets have regularly been growing at double-digit rates, albeit in some of the markets there has been a temporary blip caused by the global credit crunch. Much of the recent growth has been fuelled by an expansion in public sector health insurance coverage, which means that drug reimbursement is much more widespread than in the past. However, the growth of reimbursement systems, combined with the ongoing global economic difficulties, has put pressure on governments to introduce more rigorous price-control mechanisms than in the past. This report provides a concise examination of the pricing and reimbursement environment in seven of the most important emerging markets. In doing so, it highlights differences in the pricing methodology used in the public and private sectors, and it also focuses on differences in the pricing structure for originator drugs and generics. The report does not limit itself merely to what is happening currently, but also explores how government policy in each of the individual emerging markets is likely to shape the P&R environment in the future. The seven key emerging markets covered in this report are Brazil, China, India, Mexico, Russia, South Korea, TurkeyKey Features of this report ' The report tracks the development of the health insurance system (both public and private) in each of the seven emerging markets, and explores issues such as sources of funding and population coverage. ' The report provides a detailed analysis of the reimbursement environment in each of the seven emerging markets, paying particular attention to how it relates to the market's health insurance system.' The report provides a detailed analysis of the pricing structure in each of the seven emerging markets, differentiating between the structure that is in place for originator drugs and generics. Where applicable, it also examines how the pricing mechanism differs for the private and public sectors. ' The report provides a unique insight into the role that is played by the distribution chain from a P&R perspective, examining both formal and informal distribution margins. ' The report examines government policy in relation to pricing & reimbursement, and looks ahead to what changes in the P&R environment are likely to take place in the future. Key benefits from reading this report' Allows marketers to operate with confidence in the often complex pricing and reimbursement (P&R) environment in seven key emerging markets.' Allows marketers to prepare fully for the impact that the arrival of generic competition would cause from a P&R perspective.' Provides marketers with vital intelligence about the sometimes murky criteria that are used for the inclusion of drugs on government reimbursement lists.' Forewarns marketers about rebates on official prices that are sometimes mandatory in the public sector. ' Provides marketers with an insight into distribution practices, including kickbacks and informal margins. ' Allows marketers to plan ahead with confidence by looking ahead to the P&R policies that are likely to help shape these seven markets in the future. Key findings of this reportEach of the seven emerging markets under review has its own unique P&R environment. Even in those emerging markets where reference-pricing is used, there is a wide variation in the countries that are being referenced. Despite the expansion of public sector health insurance coverage, a high proportion of expenditure is still derived from out-of-pocket payments by consumers.The recent global economic upheaval has placed additional stresses on the P&R environment of the emerging markets, and it has encouraged the imposition of new price control mechanisms. However, despite this economic upheaval, governments in the emerging markets are pressing ahead with previous plans to expand public sector health insurance coverage (and by extension to increase the accessibility of drugs). The proporti
Published on: Mar 4, 2016
Source: www.slideshare.net


Transcripts - Pricing & Reimbursement in Emerging Markets: Analysis of pricing mechanisms and the influence of public and private sector health insurance provision

  • 1. Find Industry reports, Company profilesReportLinker and Market Statistics >> Get this Report Now by email!Pricing & Reimbursement in Emerging Markets: Analysis of pricingmechanisms and the influence of public and private sector healthinsurance provisionPublished on August 2010 Report SummaryOver the past few years, pharmaceutical sales in the emerging markets have regularly been growing at double-digit rates, albeit insome of the markets there has been a temporary blip caused by the global credit crunch. Much of the recent growth has been fuelledby an expansion in public sector health insurance coverage, which means that drug reimbursement is much more widespread than inthe past. However, the growth of reimbursement systems, combined with the ongoing global economic difficulties, has put pressureon governments to introduce more rigorous price-control mechanisms than in the past.This report provides a concise examination of the pricing and reimbursement environment in seven of the most important emergingmarkets. In doing so, it highlights differences in the pricing methodology used in the public and private sectors, and it also focuses ondifferences in the pricing structure for originator drugs and generics.The report does not limit itself merely to what is happening currently, but also explores how government policy in each of theindividual emerging markets is likely to shape the P&R environment in the future. The seven key emerging markets covered in thisreport are Brazil, China, India, Mexico, Russia, South Korea, TurkeyKey Features of this report The report tracks the development of the health insurance system (both public and private) in each of the seven emerging markets,and explores issues such as sources of funding and population coverage. The report provides a detailed analysis of the reimbursement environment in each of the seven emerging markets, paying particularattention to how it relates to the markets health insurance system. The report provides a detailed analysis of the pricing structure in each of the seven emerging markets, differentiating between thestructure that is in place for originator drugs and generics. Where applicable, it also examines how the pricing mechanism differs forthe private and public sectors. The report provides a unique insight into the role that is played by the distribution chain from a P&R perspective, examining bothformal and informal distribution margins. The report examines government policy in relation to pricing & reimbursement, and looks ahead to what changes in the P&Renvironment are likely to take place in the future.Key benefits from reading this report Allows marketers to operate with confidence in the often complex pricing and reimbursement (P&R) environment in seven keyemerging markets. Allows marketers to prepare fully for the impact that the arrival of generic competition would cause from a P&R perspective. Provides marketers with vital intelligence about the sometimes murky criteria that are used for the inclusion of drugs on governmentreimbursement lists. Forewarns marketers about rebates on official prices that are sometimes mandatory in the public sector. Provides marketers with an insight into distribution practices, including kickbacks and informal margins.Pricing & Reimbursement in Emerging Markets: Analysis of pricing mechanisms and the influence of public and private sector health insurance provision (From Slideshar Page 1/7e)
  • 2. Find Industry reports, Company profilesReportLinker and Market Statistics >> Get this Report Now by email! Allows marketers to plan ahead with confidence by looking ahead to the P&R policies that are likely to help shape these sevenmarkets in the future.Key findings of this reportEach of the seven emerging markets under review has its own unique P&R environment. Even in those emerging markets wherereference-pricing is used, there is a wide variation in the countries that are being referenced.Despite the expansion of public sector health insurance coverage, a high proportion of expenditure is still derived from out-of-pocketpayments by consumers.The recent global economic upheaval has placed additional stresses on the P&R environment of the emerging markets, and it hasencouraged the imposition of new price control mechanisms.However, despite this economic upheaval, governments in the emerging markets are pressing ahead with previous plans to expandpublic sector health insurance coverage (and by extension to increase the accessibility of drugs).The proportion of people using private sector health insurance coverage remains very limited in most of the emerging markets.However, in several markets, the uptake of private sector health insurance is growing rapidly from a small base, mainly in urbanareas.The authorities in several emerging markets have been seeking ways to encourage a greater uptake of generics instead of expensivebranded drugs. Nevertheless, in countries such as China there is scope for a higher number of innovative drugs to be reimbursed.Future growth prospects for all seven of the emerging markets remain strong.Key questions answered by this report What is the precise pricing methodology used by each of the emerging markets What role is played by the distribution chain in the pricing of drugs Are there differences in the pricing structure for local drugs and imported drugs In what way does the arrival of generic competition impact on the pricing of originator drugs Are there any special pricing requirements for drugs used by the public sector Are there any variations in pricing on a regional level How quickly is public health insurance coverage expanding Are reimbursement lists beginning to include a larger number of innovator drugs Are governments maintaining previous commitments to increase healthcare spending In what direction is government policy taking the markets from a P&R perspective Table of ContentPricing and Reimbursement in Emerging MarketsExecutive summary 8Introduction 8Brazil 9Pricing & Reimbursement in Emerging Markets: Analysis of pricing mechanisms and the influence of public and private sector health insurance provision (From Slideshar Page 2/7e)
  • 3. Find Industry reports, Company profilesReportLinker and Market Statistics >> Get this Report Now by email!China 10India 11Mexico 12Russia 13South Korea 14Turkey 15Chapter 1 Introduction 18Summary 18Recent historical perspective 19Growth drivers 20Access barriers 21Key pricing and reimbursement factors 24Reimbursement lists 24Pricing methodology 25Role played by distribution chain 26Future outlook 27Chapter 2 Brazil 30Summary 30Introduction 31Public sector provision 32Private sector provision 33Reimbursement system 34Pricing mechanism 35Price revisions 36Public sector discounts 36Pricing in practice 37Future outlook 38Chapter 3 China 42Summary 42Introduction 43Public sector provision 43Urban areas 44Rural areas 44Private sector provision 45Reimbursement system 45Essential Drugs List (EDL) 46Reimbursement levels 47Pricing mechanism 47EDL pricing 48Hospital margins 49Future outlook 49Chapter 4 India 52Summary 52Introduction 53Public sector provision 53Private sector provision 54Reimbursement system 55Pricing mechanism 56Pricing & Reimbursement in Emerging Markets: Analysis of pricing mechanisms and the influence of public and private sector health insurance provision (From Slideshar Page 3/7e)
  • 4. Find Industry reports, Company profilesReportLinker and Market Statistics >> Get this Report Now by email!Price revisions 58Distribution margins 59Future outlook 59Chapter 5 Mexico 62Summary 62Introduction 63Public sector provision 63Private sector provision 65Reimbursement system 66Pricing mechanism 66Public sector 66Private sector 67Future outlook 69Growth factors 69Further price pressure expected 69Chapter 6 Russia 72Summary 72Introduction 73Public sector provision 74Private sector provision 74Reimbursement system 75Pricing mechanism 76DLO drugs 76Non-DLO drugs 77Impact of price controls 78Future outlook 79Chapter 7 South Korea 82Summary 82Introduction 83Public sector provision 83Private sector provision 85Reimbursement system 86Pricing mechanism 87Pricing dynamics 87Future outlook 89Chapter 8 Turkey 92Summary 92Introduction 93Public sector provision 94Private sector provision 95Reimbursement system 95Prescribing practices 96Pricing mechanism 97Future outlook 98Appendix 100Methodology 100Glossary 100Pricing & Reimbursement in Emerging Markets: Analysis of pricing mechanisms and the influence of public and private sector health insurance provision (From Slideshar Page 4/7e)
  • 5. Find Industry reports, Company profilesReportLinker and Market Statistics >> Get this Report Now by email!List of FiguresFigure 2.1: Brazil: pharmaceutical sales, 2005-2009 31Figure 2.2: Brazil: private health insurance turnover, 20032009 34Figure 4.3: India: price structure for price-controlled formulations 58Figure 5.4: Mexico: number of affiliates of healthcare schemes, 2009 64Figure 7.5: South Korea: organizational structure of NHI system 84Figure 8.6: Turkey: breakdown of generic/originator products available on market 94List of TablesTable 1.1: Emerging markets: per capita spend on pharmaceuticals, 2008 20Table 1.2: Emerging markets in global context: health expenditure ratios, 20002007 23Table 2.3: Brazil: average drug price by medicine type, 20072008 38Table 4.4: India: list of scheduled bulk drugs (DPCO 1995) 57Table 5.5: Mexico: provisional health budget by sector, 2010 65Table 8.6: Turkey: distribution margins for drugs 97Pricing & Reimbursement in Emerging Markets: Analysis of pricing mechanisms and the influence of public and private sector health insurance provision (From Slideshar Page 5/7e)
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