Pharmaceutical Pricing and Reimbursement in Oncology - PayerPressure to Justify Premium Pricing of Novel Agents, PushingCo...
European countries are managing the influx of new therapies in oncology through innovative strategies.Higher levels of per...
3.2.4 Risk Sharing Agreements in the US Vis-à-vis Europe 153.3 Difference in Reimbursement for Oncology Drugs between the ...
7.4 Research Methodology 647.4.1 Introduction 647.4.2 Regulatory Bodies 647.4.3 Key Trends 647.5 Contact Us 657.6 Disclaim...
Figure 7: Pricing and Reimbursement in Oncology, the US, Estimated Cancer Cases, By Sites, Men (%),2011 22Figure 8: Pricin...
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Pharmaceutical pricing and reimbursement in oncology payer pressure to justify premium pricing of novel agents, pushing companies to risk-sharing modalities

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Pharmaceutical pricing and reimbursement in oncology payer pressure to justify premium pricing of novel agents, pushing companies to risk-sharing modalities

  1. 1. Pharmaceutical Pricing and Reimbursement in Oncology - PayerPressure to Justify Premium Pricing of Novel Agents, PushingCompanies to Risk-Sharing Modalities"Cancer Costs Call for Clever use of CapitalHealthcare systems across the globe need to find new ways to fund cancer treatments, according to anew report by healthcare experts GBI Research.The report* shows financial issues arising from oncology therapy costs in Europe and the US. Thisimplies that better insurance guidelines and a bigger cash injection is needed to support the giganticpatient population.According to the World Health Organization (WHO), around 13% of all deaths in the world are due tocancer. Principal oncology treatments include surgery, radiation therapy and chemotherapy, withmultiple modalities often used. Surgery represents the oldest form of effective cancer therapy, while theapproval of new molecularly targeted anti-cancer drugs represents an exciting new advancement inclinical oncology. These drugs offer benefits which include reduced toxicity, improvement in survival,pain reduction, and overall improvement in quality of life.Access to treatment is controlled by government policies, which are often influenced by economiclimitations, and these new anti-cancer drugs unfortunately come with a heavy price tag. Combinationtherapies are already leading the overall cost of drug therapy to increase over time, creating difficultiesfor payers who struggle to afford treatment costs. Therefore the usage of groundbreaking anti-cancerdrugs differs dramatically between countries, as less effective treatment options can be provided at farlower costs.The Agenzia Italiana del Farmaco (AIFA) – the Italian Medicines Agency – published a list of drugs fordiseases approved for reimbursement in November 2010, and oncology therapeutics were conspicuousin their absence. The exclusion of oncology drugs was partly due to high therapeutic costs, which wouldplace regional healthcare authorities in significant debt.Get your copy of this report @ http://www.reportsnreports.com/reports/175779-pharmaceutical-pricing-and-reimbursement-in-oncology-payer-pressure-to-justify-premium-pricing-of-novel-agents-pushing-companies-to-risk-sharing-modalities.htmlReport Details:Published:July 2012No.of Pages: 65Price: Single User License: US$ 3500 Corporate User License: US$ 7000
  2. 2. European countries are managing the influx of new therapies in oncology through innovative strategies.Higher levels of performance are now demanded from oncology treatments in terms of survival andremission, in order for the drug to qualify for reimbursement, as insurance bodies now scrutinize thebenefits derived from therapies more rigorously than before. The AIFA developed a health technologyassessment (HTA) system for anti-cancer drugs, to manage the delivery and funding of novel andexpensive drugs. Other European countries are adopting similar conditional reimbursement agreements,and in light of new upcoming anti-cancer drugs, it can be expected that the examination of benefits willbecome even more rigorous, as payers must allocate their budgets more prudently.Insurers across the US are being forced to cover costs for high performing chemotherapy treatments,with various states now enacting cancer drug parity laws to protect patients from financial hardships.Previously, in cases where no intravenous substitute for oral chemotherapy drugs was available, cancerpatients were forced to bear the entire financial burden, but hefty out-of-pocket costs led to a patientoutcry for help.This law represents a positive step, but it is not yet maintained among all US states, and it remains aglobal uncertainty whether costs will be covered for cancer sufferers in the future.*Pharmaceutical Pricing and Reimbursement in Oncology - Payer Pressure to Justify Premium Pricing ofNovel Agents, Pushing Companies to Risk-Sharing ModalitiesThis report is provides a comprehensive overview of the healthcare system, and the pricing andreimbursement processes in the top seven countries of the world, with detailed analysis of the differentregulatory mechanisms used in these countries. The report closely scrutinizes the major pharmaceuticalchanges and oncology-related pricing and reimbursement in these countries in the recent past and theirimpact in the near future. The countries analyzed in the report are the US, the top five Europeancountries of the UK, France, Italy, Germany and Spain; and Japan.This report is built using data and information sourced from proprietary databases, primary andsecondary research and in-house analysis by GBI Research’s team of industry experts."Table of Contents1.1 List of Tables 61.2 List of Figures 72 Pricing and Reimbursement in Oncology - Introduction 83 Pricing and Reimbursement in Oncology - Overview 93.1 Development of Oncology Drugs 123.2 Market Access and the Role of Health Economics in Cancer Drugs 133.2.1 Regulation of Cancer Drugs in Europe 133.2.2 Hospital Budgets and Patient Access to Drugs 133.2.3 Payers Managing Influx of New Therapies through Innovative Strategies 14
  3. 3. 3.2.4 Risk Sharing Agreements in the US Vis-à-vis Europe 153.3 Difference in Reimbursement for Oncology Drugs between the US and Europe 153.4 Rationalizing Costs in the US 154 Pricing and Reimbursement in Oncology - The US 164.1 Introduction 164.2 Regulatory Bodies 174.3 Trends 184.3.1 Oncology Practice and Expenditure in the US 184.3.2 Expenditure on Cancer Care Until 2020 - Costs May Increase by 27% from 2010 184.3.3 Reimbursement of Prescription Drugs - Oncology Falls under Tier Four 244.3.4 Strategies to Control Healthcare Spending 244.3.5 Oral Targeted Chemotherapeutics are the Next Paradigm in Cancer Care 254.3.6 Reimbursement Issues in Oral Chemotherapeutics 254.3.7 Oral Chemotherapy Parity Act 265 Pricing and Reimbursement in Oncology - Top Five Countries of Europe 275.1 Italy 275.1.1 Introduction 275.1.2 Regulatory Bodies 285.1.3 Trends 295.2 Spain 315.2.1 Introduction 315.2.2 Regulatory Bodies 315.2.3 Trends 325.3 Germany 345.3.1 Introduction 345.3.2 Regulatory Bodies 355.3.3 Trends 375.4 France 395.4.1 Introduction 395.4.2 Regulatory Bodies 415.4.3 Trends 435.5 The UK 475.5.1 Introduction 475.5.2 Regulatory Bodies 485.5.3 Trends 506 Pricing and Reimbursement in Oncology - Japan 556.1 Introduction 556.2 Regulatory Bodies 576.3 Trends 586.3.1 Fee Changes for the Elderly in Japan Suffering from Cancer 586.3.2 Off-label Uses of Drugs Agreed to be Given Conditional Reimbursement 586.3.3 Changes to Japan’s Pricing System for Market Leading Drugs 586.3.4 New Medicines Included in NHI List Including Eisai’s Breast Cancer Drug Halaven 587 Pricing and Reimbursement in Oncology - Appendix 607.1 Market Definitions 607.2 Abbreviations 607.3 Sources 63
  4. 4. 7.4 Research Methodology 647.4.1 Introduction 647.4.2 Regulatory Bodies 647.4.3 Key Trends 647.5 Contact Us 657.6 Disclaimer 651.1 List of TablesTable 1: Pricing and Reimbursement in Oncology, Age Standardized Cancer Incidence, Top SevenCountries, 2008 10Table 2: Pricing and Reimbursement in Oncology, Age Standardized Cancer Mortality, Top SevenCountries, 2008 11Table 3: Pricing and Reimbursement in Oncology, Examples of Innovative Reimbursement Agreements14Table 4: Pricing and Reimbursement in Oncology, the US, Expenditure for Cancer Care in the Top FiveSites ($bn), 2010 and 2020 20Table 5: Pricing and Reimbursement in Oncology, the US, Expenditure for Cancer Care in Other Sites($bn), 2010 and 2020 21Table 6: Pricing and Reimbursement in Oncology, Average Retail Coinsurance Rates, the US, By Tier (%),2009 24Table 7: Pricing and Reimbursement in Oncology, Public Pharmaceutical Expenditure, Pharmacies, 2010-2011 33Table 8: Pricing and Reimbursement in Oncology, Germany, Healthcare Expenditure by Financing Agent,$ per inhabitant, 2007, 2008, 2009 35Table 9: Pricing and Reimbursement in Oncology, France, Types of Treatment and their ReimbursementLevels 40Table 10: Pricing and Reimbursement in Oncology, Market Entry Restrictions for Cancer Drugs, the UK 51Table 11: Pricing and Reimbursement in Oncology, the UK, General Price Changes (%), 2009-2013 53Table 12: Pricing and Reimbursement in Oncology, Healthcare Expenditure, Japan, 2009 55Table 13: Pricing and Reimbursement in Oncology, Trend in Revision Rates of Reimbursement Prices,Japan, 1992-2008 56Table 14: Pricing and Reimbursement in Oncology, Change in Premiums, Japan, 2002-2008 57Table 15: Pricing and Reimbursement in Oncology, List of Drugs Introduced to NHI, Japan, 2011 591.2 List of FiguresFigure 1: Pricing and Reimbursement in Oncology, Diseased Population in the Top Seven Countries forMajor Types of Cancer (millions), 2010 9Figure 2: Pricing and Reimbursement in Oncology, Age Standardized Cancer Incidence, Top SevenCountries, 2008 10Figure 3: Pricing and Reimbursement in Oncology, Age Standardized Cancer Mortality, Top SevenCountries, 2008 11Figure 4: Pricing and Reimbursement in Oncology, the US, Total Healthcare Expenditure vs. Out-of-Pocket Expenditure (%), 2009 17Figure 5: Pricing and Reimbursement in Oncology, the US, Expenditure for Cancer Care ($bn), 2010 and2020 19Figure 6: Pricing and Reimbursement in Oncology, the US, Expenditure for Cancer Care in the Top FiveIndications ($bn), 2010 and 2020 20
  5. 5. Figure 7: Pricing and Reimbursement in Oncology, the US, Estimated Cancer Cases, By Sites, Men (%),2011 22Figure 8: Pricing and Reimbursement in Oncology, the US, Estimated Cancer Cases, By Sites, Women (%),2011 23Figure 9: Pricing and Reimbursement in Oncology, Total Per-capita Expenditure on Pharmaceuticals, TopFive Countries of Europe and the US, $PPP, 1990-2009 27Figure 10: Pricing and Reimbursement in Oncology, NHS and Private Composition of PharmaceuticalExpenditure, Italy, %, 2009 28Figure 11: Pricing and Reimbursement in Oncology, Public Pharmaceutical Expenditure, Pharmacies,Growth Rates (%), 2010-2011 32Figure 12: Pricing and Reimbursement in Oncology, Germany, Healthcare Expenditure by FinancingAgent, $ per inhabitant, 2007, 2008, 2009 34Figure 13: Pricing and Reimbursement in Oncology, Germany, Structural Reforms by AMNOG, 2011 37Figure 14: Pricing and Reimbursement in Oncology, European Counties, the US and Japan, TotalHealthcare Expenditure vs. Out-of-Pocket Expenditure, 2009 39Figure 15: Pricing and Reimbursement in Oncology, Regulatory Bodies and Functions, France 41Figure 16: Pricing and Reimbursement in Oncology, HTA to P&R Decisions, France 42Figure 17: Pricing and Reimbursement in Oncology, Public and Private Expenditure on Health as % ofTotal Expenditure on Health, 2009 47Figure 18: Pricing and Reimbursement in Oncology, the UK, NHS Expenditure on Medicines ($bn) vs. NHSMedicines Cost Per Capita ($), 2000-2009 49Figure 19: Pricing and Reimbursement in Oncology, Life Expectancy at Age 65 Years, Males and Females,Japan, 2009 56Contact:TX, Dallas North - Dominion Plaza,17304, Preston Road,Suite 800, Dallas 75252.+ 1 888 391 5441mailto:sales@reportsandreports.com

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