This document summarizes information from a report about prescription drug costs and spending in the United States. It notes that 53 new medicines were approved by the FDA in 2020 and discusses trends in drug spending growth rates remaining in line with overall health care spending increases. However, it also outlines challenges patients face in affording medications due to high deductibles, coinsurance, and other out-of-pocket costs not reduced by negotiated rebates and discounts. The report examines spending and policy issues across the entire U.S. health care system that contribute to the complex drug pricing landscape.
Prescription Medicines - Costs in Context - October 2018PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context - October 2018PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context January 2019PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines Costs in Context - June 2019PhRMA
We are in a new era of medicine where breakthrough science is transforming care with innovative treatment approaches and enabling us to more effectively treat chronic disease, the biggest cost driver.
Prescription Medicines - Costs In Context March 2019PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context - September 2018PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context - September 2018PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context - August 2018PhRMA
Discussions about the cost and affordability of medicines – and health care more broadly – are important. At the same time, it is important to look at costs across the health care system and not just the share going toward life changing medicines.
On June 11, CBO will present preliminary findings of a study of specialty drugs to be released by the agency later this year. The presentation provides information on the prices for specialty drugs, net of rebates and discounts, in Medicare Part D and Medicaid over the 2010–2015 period; the increase in net spending on specialty drugs in each program; and total net spending and out-of-pocket costs for specialty drugs among Medicare Part D enrollees who use such drugs.
Presentation by Anna Anderson-Cook, Jared Maeda, and Lyle Nelson (all of CBO’s Health, Retirement, and Long-Term Analysis Division) at the conference of the American Society of Health Economists.
Third-party administrators (TPAs), employers and employees are increasingly concerned about the growing cost of specialty drugs. Relief, WellDyneRx believes, will come to those employers and TPAs that (1) encourage specific public policy changes and (2) partner with pharmacy benefit managers (PBMs) that own best-of-breed specialty pharmacies.
Prescription Medicines - Costs in Context January 2019PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines Costs in Context - June 2019PhRMA
We are in a new era of medicine where breakthrough science is transforming care with innovative treatment approaches and enabling us to more effectively treat chronic disease, the biggest cost driver.
Prescription Medicines - Costs In Context March 2019PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context - September 2018PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context - September 2018PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context - August 2018PhRMA
Discussions about the cost and affordability of medicines – and health care more broadly – are important. At the same time, it is important to look at costs across the health care system and not just the share going toward life changing medicines.
On June 11, CBO will present preliminary findings of a study of specialty drugs to be released by the agency later this year. The presentation provides information on the prices for specialty drugs, net of rebates and discounts, in Medicare Part D and Medicaid over the 2010–2015 period; the increase in net spending on specialty drugs in each program; and total net spending and out-of-pocket costs for specialty drugs among Medicare Part D enrollees who use such drugs.
Presentation by Anna Anderson-Cook, Jared Maeda, and Lyle Nelson (all of CBO’s Health, Retirement, and Long-Term Analysis Division) at the conference of the American Society of Health Economists.
Third-party administrators (TPAs), employers and employees are increasingly concerned about the growing cost of specialty drugs. Relief, WellDyneRx believes, will come to those employers and TPAs that (1) encourage specific public policy changes and (2) partner with pharmacy benefit managers (PBMs) that own best-of-breed specialty pharmacies.
Medicines Use and Spending Shifts: A Review of the Use of MedicinesIMS Health US
Growth in spending on medicines was higher in 2014 than any year since 2001, and
exceeded forecast overall healthcare spending growth for the first time since 2011.
As 2014 was also a landmark year in the implementation of the Affordable Care Act,
understanding the specific drivers of medicine spending growth is important for decisionmakers
across the healthcare system.
In this report we bring together several perspectives on 2014: total system spending on
medicines at an aggregate and segmented level; the evolution of healthcare demand, delivery
and payment systems; patient out-of-pocket costs for medical and pharmacy benefits including
retail prescription co-pays; and transformations in disease treatment resulting from newly
approved medicines.
Presentation by Michael Cohen, an analyst in CBO’s Health Analysis Division, and Tamara Hayford, Chief of CBO’s Health Policy Studies Unit, at the Congressional Research Service.
Global pharmaceutical companies are modeled with a supply chain, which ensures that the right drug reaches the right people at the right time and in the right condition. The supply chain also ensures 100% product availability at optimum cost by carrying huge inventory, which maintains 100% fill rate. Manufacturers are trying to cut down development time to save costs. For example, a drug manufacturer who can trim development time by 19% can save up to USD 100 million. But if a drug is getting delayed to reach the market, the time delay costs the company around USD 1 million a day. So, pharmaceutical companies today are designing the supply chain to be as responsive as possible to reduce entry time to the market thereby increasing profit margins.
Addressing Rising Health Care Costs | CVS HealthCVS Health
CVS Health is committed to lowering health care costs while delivering high-quality care to communities across the country. Learn more: https://cvshealth.com/thought-leadership/addressing-rising-health-care-costs
How is drug spending affected in the year 2017Steve Martin
As per the reports published in American Journal of Health-System Pharmacy (AJHP) in the year 2016, national trends in prescription drug expenditures were projected to increase by 6 to 8% in 2017 across all healthcare settings.
Prescription Medicines - Insulin Costs in ContextPhRMA
A century ago, patients were treated with animal insulins. Today, biopharmaceutical companies produce insulins that operate at the molecular level, more closely resembling insulin released naturally in the body and more effectively managing the disease. The options available today also help meet a wide range of unmet needs, providing patients with the tools necessary to stay adherent and healthy – saving costs throughout the health care system. However, this innovation isn’t enough if patients can’t afford their insulin and other medicines at the pharmacy.
Prescription Medicines: International Costs in ContextPhRMA
Our new Prescription Medicines: International Costs in Context explains how medicines benefit patients, health care systems, and the global economy. Advances in treatment are tacking some of the world’s greatest public health challenges. These treatments provide critical savings for health care systems by reducing the need for more costly services. What’s more is the profound impact that biopharmaceutical companies have on the global economy, including the creation of high-skill jobs, R&D investment, and medicines that improve worker productivity.
2016 Report: Medicines in Development for Alzheimer's DiseasePhRMA
Today, more than 5 million Americans have Alzheimer’s disease. The disease devastates the minds of patients, creates substantial burdens for families and caregivers, and currently costs the health care system more than $200 billion a year. These sobering statistics are projected to get much worse as the 76 million American baby boomers age.
This report shows that America's Biopharmaceutical Research Companies Are Developing More Than 70 Medicines for Alzheimer’s Disease
2015 Report: Medicines in Development for Heart Disease & StrokePhRMA
According to the American Heart Association, someone in the United States dies from cardiovascular disease every 40 seconds, and more than 85 million Americans have at least one form of the disease. Heart disease has been the leading cause of death in the United States since 1921, but these numbers are declining. Read this report by PhRMA - in partnership with the Association of Black Cardiologists - on the nearly 200 medicines in development for heart disease & stroke.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
2. 2
CONFIDENTIAL
We are in a New Era of Medicine Where Breakthrough
Science is Transforming Patient Care
53 New Medicines Were Approved by the FDA in 2020
Cancer death rate posts biggest
one-year drop ever
Newly approved drug being
called ‘game changer’ for people
who suffer from hemophilia
Reasons for hope: the drugs,
tests and tactics that may
conquer coronavirus
Cancer Death Rate Game Changer Coronavirus Vaccine
Source: US FDA. Center for Drug Evaluation and Research (CDER) Advancing Health through Innovation. 2020 New Drug Approvals.
Note: Due to lack of data availability, novel approvals are not inclusive of medicines approved by the Center for Biologics Evaluation and Research (CBER) in 2020.
Prescription Medicines: Costs in Context www.phrma.org/cost
3. 3
CONFIDENTIAL
Though Growth in Medicine Prices and Spending Remains
in Line With Inflation, Many Patients Still Struggle to Afford
their Medicines
Brand Medicine Prices Retail Medicine Spending
2019
1.7%
2019*
3.2%
* Projected
Prescription Medicines: Costs in Context www.phrma.org/cost
4. 4
CONFIDENTIAL
Insurers and PBMs Have a Lot of Leverage to Hold
Down Medicine Costs
Negotiating poweris increasingly concentrated amongfewer pharmacy benefit
managers (PBMs).
Source: Drug Channels Institute, March 2021.
24%
32%
21%
23%
Top 3
Market Share:
77%
OptumRx (UnitedHealthGroup)
CVS Health (Caremark)
Express Scripts
All Other
Insurers determine:
FORMULARY
if a medicine is covered
TIER PLACEMENT
patient cost sharing
ACCESSIBILITY
utilization management through
prior authorization or fail first
PROVIDER INCENTIVES
preferred treatment guidelines
and pathways
Prescription Medicines: Costs in Context www.phrma.org/cost
5. 5
CONFIDENTIAL
Spending on Retail and Physician-administered Medicines
Represents Just 14% of Health Care Spending
Source: PhRMA analysis of CMS National Health Expenditures, Altarum Institute, and Berkeley Research Group data. May not sum to 100% due to rounding.
8%
12%
14%
17%
14%
4%
31%
Admin Costs
Home Health & Nursing Home Care
Prescription Medicines
Physician & Clinical Services
Other**
Dental Services
Hospital Care
U.S.
Health Care
Spending,
2018
7% Brand Manufacturers
2% Generic Manufacturers
5% Supply Chain Entities
Prescription Medicines: Costs in Context www.phrma.org/cost
6. 6
CONFIDENTIAL
91% of All Medicines Dispensed in the United States
are Generics
Source: IMS Health. Drug Channels Institute, March 2021; Association for Accessible Medicines. “Generic Drug & Biosimilars Access & Savings Report,” 2020.
Prescription Medicines: Costs in Context www.phrma.org/cost
19%
33%
43%
52%
72%
88% 90% 91%
1984 1990 1996 2002 2008 2014 2018 2020
nearly
$2.2 trillion
10-year savings
(2010 - 2019)
7. 7
CONFIDENTIAL
Medicine Spending is Projected to Grow in Line with
Health Care Spending Through Next Decade
In 7 of the last 10 years, Retail Drug Spending Growth was below Total Health
Spending Growth
Source: CMS National Health Expenditures Report 2020
Note: Total retail sales include brand medicines and generics.
Prescription Medicines: Costs in Context www.phrma.org/cost
Total Health Spending Growth Rate Prescription Drug Spending Growth Rate
Annual
Growth
Rate
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2024 2025 2026 2027 2028
14%
12%
10%
8%
6%
4%
2%
0%
Projections show retail
drug spending growth
in line with overall
health spending
8. 8
CONFIDENTIAL
Nearly Half of Spending on Brand Medicines Goes to Entities
Other Than the Manufacturers Who Developed Them
Percent of Total Spending on Brand
Medicines Received by Manufacturers
and Other Entities, 2018
Rebates, discounts, fees and other
price concessions have more than
doubled since 2012
2012 2020
$74B
$187B
54%
46%
Source: Berkeley Research Group, 2020. Source: Drug Channels Institute, March 2021.
Prescription Medicines: Costs in Context www.phrma.org/cost
Brand Manufacturer Other Entity Received
9. 9
CONFIDENTIAL
Insurers are Increasingly Shifting Costs to Patients
Through the Use of Deductibles and Coinsurance
Source: PWC, KFF
Prescription Medicines: Costs in Context www.phrma.org/cost
The use of four or more cost-sharing tiers is
becoming more common on employer plans
Percent of plans with deductibles
on prescription drugs
23%
52%
2012 2017
4%
7%
11%
14%
23% 23%
44% 45%
48%
2005 2007 2009 2011 2013 2015 2017 2019 2020
10. 10
CONFIDENTIAL
Too Often, Negotiated Savings Do Not Make Their Way
to Patients at the Pharmacy Counter
Half of commercially insured patients’
out-of-pocket spending for brand
medicines is based on the full list price
Cost sharing for nearly 1 in 10 brand
prescriptions is based on list price
Source: IQVIA. August 2020.
Prescription Medicines: Costs in Context www.phrma.org/cost
51.4%
14.3%
34.3%
49%
Copay
Deductible
Coinsurance
11. 11
CONFIDENTIAL
Patients Face High Out-of-pocket Costs at the Pharmacy
Counter Even Though Total Spending on Other Parts of
the Health Care System is Far Higher
Half of commercially insured patients’
out-of-pocket spending for brand
medicines is based on the full list price
Cost sharing for nearly 1 in 10 brand
prescriptions is based on list price
Source: Drug Channels Institute analysis of National Health Expenditure Accounts, Office of the Actuary in the Centers for Medicare & Medicaid Services, December 2020. Outpatient prescription drug figures exclude
inpatient prescription drug spending within hospitals and nearly all provider-administered outpatient drugs. Figures in billions.
Prescription Medicines: Costs in Context www.phrma.org/cost
Total U.S. Spending
Hospital Care Retail Prescription Drugs
$1,192B
$370B
Total Patient Out-of-Pocket Spending
Hospital Care Retail Prescription Drugs
$53.7B
$35.9B
$822B
12. 12
CONFIDENTIAL
Hospitals Account for 1/3 of All U.S. Health Care Spending
and Contribute to Patient Out-of-pocket Costs by Marking
Up Medicines
Nearly one in five hospitals marks
up medicine prices to 700% or
more of their acquisition cost
If a hospital purchased a medicine
for $150, a 700% markup could
result in patients being billed
$1,050 for that medicine
An analysis found that 320
hospitals mark up some
medicine prices at least 1,000%
Source: The Moran Company. Hospital Charges and Reimbursement
for Medicines: Analysis of Cost-to Charge Ratios. September 2018.
Prescription Medicines: Costs in Context www.phrma.org/cost
1,000%
Amount
paid by
hospital
Amount
billed by
hospital
$1,050
$150
13. 13
CONFIDENTIAL
Hospitals and Other Health Care Providers Use the 340B
Drug Discount Program to Retain an Increasing Share of
Medicine Spending
Source: Berkeley Research Group.
Prescription Medicines: Costs in Context www.phrma.org/cost
The amount of brand medicine spending retained by hospitals, pharmacies and providers
grew 2x between 2013 and 2018.
$0B
$10B
$20B
$30B
$40B
$50B
$60B
2013 2018
Other Provider…
9X
$3.5B
$21.2B
$30.6B
$18.0B
14. 14
CONFIDENTIAL
Medicine Spending in the United States is In Line with
Spending Around the World
Prescription Medicines as
a Percentage of Total
Health Care Spending
Note: Total health care spending includes hospital care, physician and clinical services, home health and nursing home care, government administration and net cost of private health insurance, dental, home health and other professional
services as well as durable medical equipment.
Source: OECD Health Statistics Database (accessed February 2016); Altarum Institute, 2015, A ten year projection of the prescription drug share of national health expenditures including non-retail.
Prescription Medicines: Costs in Context www.phrma.org/cost
15. 15
CONFIDENTIAL
More Medicines are Available to U.S. Patients as Compared
with Other Countries that Set Prices Artificially Low
The 5-year survival rate for all cancers is 42% higher for men and 15% higher for
women in the U.S. than in Europe.
Source: PhRMA analysis of IQVIAAnalytics Link and U.S. Food and Drug Administration (FDA), European Medicines Agency (EMA) and Japan's Pharmaceuticals and Medical Devices Agency (PMDA) data. June 2020. Note: New active
substances approved by FDA, EMA and/or PMDA and first launched in any country between January 1, 2011, and December 31, 2019. Many launched medicines are subject to additional government coverage restrictions. Updated March 2021.
Prescription Medicines: Costs in Context www.phrma.org/cost
87%
63%
59%
51% 50%
46%
39%
United States Germany United Kingdom Japan France Canada Australia
Number of New Medicines Available by Country, 2011-2019
16. 16
CONFIDENTIAL
PhRMA Created the Medicine Assistance Tool, or MAT,
To Help Patients Navigate Medicine Affordability
MAT makes it easier for those struggling to afford their medicines to find and learn
more about various programs that can make prescription medicines more affordable.
Prescription Medicines: Costs in Context www.phrma.org/cost
A search engine to connect patients with
900+
assistance programs offered by
biopharmaceutical companies, including
some free or nearly free options
Resources to help patients
navigate their insurance coverage
Links to biopharmaceutical
company websites where
information about the cost of a
prescription medicine is available
The Medicine Assistance Tool Includes:
17. 17
CONFIDENTIAL
PhRMA Is Working to Fix the Health Care System So It
Works Better for Patients
Improving Patient
Affordability
Fixing Market
Incentives
Shifting Toward
Value
Increasing
Competition
• Require insurers & PBMs to pass through negotiated rebates and discounts
• Establish an annual cap on patient out-of-pocket costs in Part D
• Allow patients to spread costs throughout the year
• Lower patients’ cost sharing from 25% to 20% in Part D
• Delink supply chain payments from list prices
• Reduce 340B distortions
• Citizen petitions
• Patent settlements
• Patent transparency
• Remove barriers to innovative payment arrangements
• Identify better tools for value assessment
Prescription Medicines: Costs in Context www.phrma.org/cost