UK ePharmacy Market Analysis Sample Report

UK ePharmacy
Market Analysis
A sample report on
www.insights10.com
Includes Market Size, Market Segmented by Types
and Key Competitors (Data forecasts from 2022 – 2030F)

This report presents a strategic analysis of the UK ePharmacy Market
and a forecast for its development in the medium and long term. It provides
a comprehensive overview of the market value, dynamics, segmentation,
main players, growth and demand drivers, challenges & future outlook, etc.
This is one of the most comprehensive reports about the UK ePharmacy
Market, and offers unmatched value, accuracy, and expert insights

3
A Sample Report on UK ePharmacy Market Analysis I Confidential
Report Scope
Report Attribute Details
Number of Pages 70-80
Base Year for Estimation 2022
Forecast Period 2023-2030
Report Coverage
Market Overview, Revenue Forecast, Market Segmentation, Growth Factors and Trends,
Competitive Landscape, Key Company Profiles, Government Policies, Regulatory Landscape,
Reimbursement Scenario
Quantitative Units Revenue in USD Million/Billion (Mn/Bn)
Research Approach Secondary Research (60%), Primary Research (40%)
Click on the icon to know the detailed methodology

4
Table of Content
CONTENT PG. NO.
1. ePharmacy Overview 12-24
1.1. Overview
1.2. UK Overview
1.3. Economic Overview: UK
1.4. ePharmacy Market in UK
1.5. Healthcare Services Market in UK
1.6. Healthcare Scenario in UK
1.7. Health Insurance Coverage: UK
1.8. Budget of the Government for Public Insurance
1.9. Mergers and Acquisitions
2. Market Size and Forecasting 25-29
2.1 Market size and forecasts (Excel and Methodology)

5
Table of Content
CONTENT PG. NO.
2.2. Market Segmentation
2.2.1. By Product Type
2.2.2. By Type
3. Market Dynamics 30-34
3.1. Market Growth Drivers
3.1.1. Increasing User Penetration of ePharmacy
3.1.2. Accessibility and Convenience
3.1.3. Increasing e-commerce Platform
3.2. Market Restraints
3.2.1. Data Breaches and Cyberthreats
3.2.2. Lack of Specific Legislative Framework
3.2.2. Prescription Verification

6
Table of Content
CONTENT PG. NO.
4. Competitive Landscape 35-45
4.1. Major Market Share
4.2. Key Company Profile
4.2.1. Pharmacy2u
4.2.1.1. Overview
4.2.1.2. Product Applications & Services
4.2.1.3. Recent Developments
4.2.1.4. Partnerships Ecosystem
4.2.1.5. Financials (Based on Availability)
4.2.2. LloydsPharmacy
4.2.2.1. Overview

7
Table of Content
CONTENT PG. NO.
4.2.3. Chemist4U
4.2.3.1. Overview
4.2.4. The Independent Pharmacy
4.2.4.1. Overview

8
Table of Content
CONTENT PG. NO.
4.2.5. AYP Healthcare
4.2.5.1. Overview
4.2.6. Well Pharmacy
4.2.6.1. Overview

9
Table of Content
CONTENT PG. NO.
4.2.7. Superdrug Online Doctor
4.2.7.1. Overview
4.2.8. e-Surgery
4.2.8.1. Overview

10
Table of Content
CONTENT PG. NO.
4.2.9. Simple Online Pharmacy
4.2.9.1. Overview
4.2.10. MedExpress
4.2.10.1. Overview

11
Table of Content
CONTENT PG. NO.
5. Reimbursement Scenario 46-53
5.1. Reimbursement Regulation
5.2. Reimbursement Process for Diagnosis
5.3. Reimbursement Process for Treatment
5.4 Reimbursement Process – Medicare
5.5 Reimbursement Process - Medicaid
6. Methodology & Scope 54-59

UK ePharmacy Market Analysis
1. ePharmacy Overview

13
Overview of Global ePharmacy Trends
Top 10 ePharmacy Trends ▪ Please be aware that this sample report is
intended to provide you with a brief
overview of the kind of information and
analysis that will be presented in the final
report
▪ In this section you will get an
understanding of the topic, which includes
the prevalence of the disease, the
application of medical devices, new
technology, and other details related to the
topic
▪ In order to obtain access to all of the
information that you are seeking, you will
need to purchase the final report
▪ Final report will be comprehensive and
detailed, and it will include data, analysis,
trends, and other relevant information
related to the topic or subject matter of
interest
Increased Online Presence
Increased online presence of
traditional and digital-only e-
pharmacies
Prescription Delivery Services
Offering prescription delivery services
for convenience and accessibility
Mobile Applications
Growing focus on mobile applications
for convenient access to e-pharmacy
services.
Expanded Product Range
Diversifying product range beyond
medications to include health and
wellness items
Telehealth and Remote
Consultations
Integration of telehealth services for
remote consultations with healthcare
professionals
Personalization and
Customization
Utilizing customer data for
personalized recommendations and
tailored healthcare solutions
AI-Powered Chatbots
AI-powered chatbots for real-time
customer support and healthcare
information
Digital Health Records
Integration of digital health records for
easy access to medical history and
prescriptions

14
1.1 Statistics at a Glance: The Burden of ePharmacy in the World (continued)
North America
~ Market Size of
$XX Bn
Europe
~Revenue to reach
$XX Bn by 2027
Asia
-Fastest CAGR
UK
~Market Size of
$XX Bn
UK Market
~$XX Bn Market

15
1.2 UK Overview
6.73 crores
Is the total
population of UK in
2021
40.7
Is the median age
in UK
$31.3 Mn
Gross domestic
product (GDP) of UK
$46,510.28
GDP per capita
of UK
▪ Please be aware that this sample report is
report
understanding of the demographics of the
country/region, which includes the
population, GDP, healthcare expenditure
and other details related to the topic
interest

16
1.3 Economic Overview: UK
XX
XX
2020 2021 2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2023F
Population of UK, (2020-2030)
XX
XX
2020 2021 2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2023F
GDP of UK, (2020-2030)
Population Split (2023)
55-64
0-14
15-24
25-54
65+
Male
49%
Female
51%
By Age Group
By Gender
▪ In this section you will get an understanding of the demographics
of the country/region, which includes the population, GDP,
healthcare expenditure and other details related to the topic
▪ In order to obtain access to all of the information that you are
seeking, you will need to purchase the final report
▪ Final report will be comprehensive and detailed, and it will
include data, analysis, trends, and other relevant information
related to the topic or subject matter of interest

17
1.4 Overview of ePharmacy in UK
Highlights of ePharmacy in UK
▪ Please be aware that this sample report
is intended to provide you with a brief
analysis that will be presented in the
final report
understanding of the topic, which
includes the prevalence of the disease,
the application of medical devices, new
technology, and other details related to
the topic in UK
information that you are seeking, you
will need to purchase the final report
detailed, and it will include data,
analysis, trends, and other relevant
information related to the topic or
subject matter of interest
US$0.89 Bn
Is projected online
pharmacy revenue
in UK in 2023
39.35%
Is the user
penetration of e
Pharmacies in 2023
in UK
47.14%
Is the expected user
penetration of
ePharmacy in UK by
2027
US$33.07
Is the expected
average revenue per
user (ARPU) of
ePharmacy in UK

18
1.5 Healthcare Services in UK
XX XX XX XX XX XX XX XX XX
2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2030F
UK Healthcare Services Market Forecast, 2022-2030 (in $Bn)
▪ Please be aware that this sample report is intended to provide you with a brief overview of the kind of information and analysis that will be
presented in the final report
▪ In this section you will get an understanding of the overall healthcare services market in UK, which includes the market size, current trends
▪ In order to obtain access to all of the information that you are seeking, you will need to purchase the final report
▪ Final report will be comprehensive and detailed, and it will include data, analysis, trends, and other relevant information related to the topic or
Illustrative

19
1.6 Healthcare Scenario in UK
ePharmacy Development Process: The process of developing a ePharmacy drug is complex and involves many stages, from preclinical
research to clinical trials to regulatory approval. Here is a simplified diagram of the ePharmacy drug development process:
o Preclinical Research: Researchers identify potential drug candidates and test them in the lab
o Phase 1 Clinical Trials: Small studies are conducted to test the safety and dosage of the drug in humans
o Phase 2 Clinical Trials: Larger studies are conducted to test the effectiveness of the drug in treating ePharmacy
o Phase 3 Clinical Trials: Even larger studies are conducted to compare the new drug to standard treatments and evaluate its safety and
effectiveness
o Regulatory Approval: The drug is reviewed by regulatory agencies such as the FDA and approved for use in the US market
Fast Track
▪ Fast track is a process designed to facilitate the development, and expedite the review of drugs to treat
serious conditions and fill an unmet medical need
Breakthrough
Therapy
▪ A process designed to expedite the development and review of drugs which may demonstrate substantial
improvement over available therapy
Accelerated
Approval
▪ These regulations allowed drugs for serious conditions that filled an unmet medical need to be approved
based on a surrogate endpoint
Priority Review ▪ A Priority Review designation means FDA’s goal is to take action on an application within 6 months
FDA has developed several approaches to making drugs available as quickly as possible, while still ensuring their safety and
effectiveness. Here are four of these approaches:
Illustrative

20
1.7 Health Insurance Coverage: US
1.0
18.9
18.4
35.7
2.5
3.5
10.2
54.3
66.0
91.7
8.3
VA and CHAMPVA
Medicaid
Medicare
Any public plan
TRICARE
Marketplace
Direct-purchase
Employment-based
Any private plan
With health insurance
Uninsured
▪ In 2021, most people (91.7%) had health insurance coverage at some point during 2021 and 8.3 % of people were uninsured for the entire
calendar year
▪ More people had private health insurance (66%) than public coverage (35.7%)
▪ Employer-based insurance was the most common subtype of health insurance in the civilian, noninstitutionalized population (54.3%),
followed by Medicaid (18.9%), Medicare (18.4%), direct-purchase insurance (10.2%), TRICARE (2.5%), and VA and CHAMPVA health care
(1%)
Coverage Type 2020 2021 Change %
Total 327,521 328,074
Any health plan 299,230 300,887 0.4
Any private plan 217,896 216,366 –0.6
Employment-based 178,737 178,285 –0.2
Direct-purchase 33,869 33,555 –0.1
Marketplace coverage 10,924 11,389 0.1
TRICARE 9,165 8,299 –0.3
Any public plan 112,925 117,095 1.2
Medicare 58,541 60,226 0.5
Medicaid 58,778 61,940 0.9
VA and CHAMPVA 2,967 3,151 0.1
Uninsured 28,291 27,187 –0.4
% of People by Type of Health Insurance Coverage
(2021)
Number of People By Health Insurance Coverage
Illustrative

21
1.8 Budget of UK Government for Public Insurance
Proposed Budget By Category
Outlays 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2022-31
In Billions Of Dollars
Medicare $769 $709 $766 $841 $840 $947 $1,014 $1,085 $1,227 $1,178 $1,325 $1,412 $10,633
Medicaid $458 $521 $571 $582 $616 $645 $674 $698 $734 $768 $801 $837 $6,926
As % Of GDP
Medicare 3.7% 3.2% 3.3% 3.4% 3.3% 3.6% 3.7% 3.8% 4.1% 3.8% 4.1% 4.2% 3.7%
Medicaid 2.2% 2.4% 2.4% 2.4% 2.4% 2.4% 2.4% 2.4% 2.5% 2.5% 2.5% 2.5% 2.4%
▪ National Health Expenditures (NHE) grew 2.7% to $4.3 trillion in 2021, or $12,914 per person, and accounted for 18.3% of Gross Domestic Product (GDP)
▪ Medicare spending grew 8.4% to $900.8 billion in 2021, or 21% of total NHE
▪ Medicaid spending grew 9.2% to $734.0 billion in 2021, or 17% of total NHE
▪ Private health insurance spending grew 5.8% to $1,211.4 billion in 2021, or 28% of total NHE
▪ Out of pocket spending grew 10.4% to $433.2 billion in 2021, or 10% of total NHE
▪ Other Third Party Payers and Programs and Public Health Activity spending declined 20.7% in 2021 to $596.6 billion, or 14% of total NHE
▪ Hospital expenditures grew 4.4% to $1,323.9 billion in 2021, slower than the 6.2% growth in 2020
▪ Physician and clinical services expenditures grew 5.6% to $864.6 billion in 2021, slower growth than the 6.6% in 2020
▪ Prescription drug spending increased 7.8% to $378.0 billion in 2021, faster than the 3.7% growth in 2020
▪ Largest shares of total health spending were sponsored by the federal government (34%) and the households (27%). The private business share of health
spending accounted for 17% of total health care spending, state and local governments accounted for 15%, and other private revenues accounted for 7%
Illustrative

22
1.9 Mergers and Acquisitions
$6.0
$7.7
$10.5
$16.7
$6.8
$11.7
1H 2020 2H 2020 1H 2021 2H 2021 1H 2022 2H 2022
82
112 107 107
89
110
1H 2020 2H 2020 1H 2021 2H 2021 1H 2022 2H 2022
57% of the total deal volume are done by strategic buyers and the rest 43% are done by financial buyers in 2020
RCM M&A Deal Value Trend ($Bn) RCM M&A Deal Volume Trend
Buyer Composition: Strategic Vs Financial (2020)
59%
41% 41%
59% 58%
42%
61%
39%
$0- $25 $25-$50 $50-$100 $100+
Strategic Buyers
Financial Buyers
Buyer Type by Deal Size
($Mn)
Illustrative

23
1.9 Mergers and Acquisitions (continued)
Company Name Type
Amount /
Duration
Year Key Pointers
Zur Rose partnership
with Medpex
Merger - 2022
▪ Zur Rose Group announced that the group had completed the
operational integration of the Medpex brand at the Heerlen facility
BD (Becton, Dickinson
and Company)
acquired MedKeeper
Acquisition -
July 2022
▪ BD (Becton, Dickinson and Company) (NYSE: BDX), a leading
global medical technology company, announced today it has
acquired MedKeeper, a provider of modern, cloud-based
pharmacy management applications
▪ MedKeeper strategically complements BD's existing presence in
the pharmacy – where the company has pioneered solutions in
compounding, logistics workflow, controlled substance
management and inventory optimization.tion
Latest Deals In UK

24
1.9 Mergers and Acquisitions(continued)
Latest Deals In UK
Company Name Type
Amount /
Duration
Year Key Pointers
Merger -
Acquisition -
Illustrative

2. Market Size and Forecasting

26
2.1 Market size and forecasts (Excel and Methodology)
XX
XX
2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2030F
UK ePharmacy Market Forecast, 2022-2030 (in $Bn)
final report
understanding of the overall Healthcare
Insurance market in Malaysia, which
includes the market size, current trends
Click on the icon to know the
methodology and assumption
2023 2024 2025 2026 2027 2028 2029 2030
Major Markets Patient
(Mn)
2.74 2.82 2.90 2.94 2.98 3.02 3.07 3.12
UK Patient Size (Bn) 0.51 0.61 0.68 0.69 0.70 0.71 0.72 0.73
% of US Patients 18.75% 21.70% 23.56% 23.45% 23.42% 23.39% 23.34% 23.45%
Global Market Size (Bn $) 3,620 3,780 3,950 4,128 4,314 4,508 4,711 4,937
UK Market Size (Bn $) 61 74 84 87 91 95 99 106
Illustrative

27
2.2 Snapshot of ePharmacy Market Segmentation
▪ In this section you will get an understanding of the segmentations which will cover the UK ePharmacy Market
By Type
Prescription Medicine
Over the Counter Medicine
Analgesics
By Product Type
Skin Care
Dental Care
Cold and Flu
Vitamins and Minerals
Others

28
UK ePharmacy Market Share, By Product Type (2022)
Prescription
Medications, 65%
Over the Counter
Medications
▪ Prescription medication market in UK is
a significant component of the overall
ePharmacy treatment market
final report
2.2.1 Market Segmentation: By Product Type
Illustrative

29
UK ePharmacy Market Share, By Type (2022)
Analgesics
Skin Care, 38%
Dental Care, 20%
Clold and Flu, 15%
Vitamins and
Minerals, 10%
Others, 12%
2.2.2 Market Segmentation: By Type
▪ Analgesics ePharmacy market in UK is
a significant component of the overall
ePharmacy market
final report
Illustrative

3. Market Dynamics

31
3.1 Market growth drivers
▪ ePharmacies offer the convenience of ordering medications and
healthcare products online from the comfort of one's home. This
accessibility appeals to individuals with busy lifestyles, limited mobility, or
those living in remote areas
▪ Please be aware that this sample report is intended to provide you with a
brief overview of the kind of information and analysis that will be
presented in the final report
▪ In order to obtain access to all of the information that you are seeking,
you will need to purchase the final report
▪ Final report will be comprehensive and detailed, and it will include data,
analysis, trends, and other relevant information related to the topic or
2010 2022 2030
3.1.1 In UK the user penetration of ePharmacy will be 39.35% in 2023 and is expected to hit 47.14% by 2027
ePharmacy Use In UK

32
3.1 Market growth drivers
▪ E-pharmacies can assist secure the provision of authentic and approved pharmaceuticals (a wide range of drugs that are safe for use)
at reasonable rates (by removing intermediaries and giving discounts) and with greater ease of access (online platform, home delivery
& improved digital payment infrastructure)
▪ As a result of the convenience and value they provide, E-Pharmacies are predicted to be generally embraced in UK
▪ Please be aware that this sample report is intended to provide you with a brief overview of the kind of information and analysis that will
be presented in the final report
▪ Final report will be comprehensive and detailed, and it will include data, analysis, trends, and other relevant information related to the
topic or subject matter of interest
3.1.2 In the UK, ePharmacies play a crucial role in providing secure access to authentic and approved
pharmaceuticals at affordable prices, with enhanced convenience through online platforms, home delivery, and
improved digital payment infrastructure

33
3.1 Market growth drivers (continued)
Penetration rate of e-commerce in UK
3.1.3 Efficiency of ePharmacies in delivering low-cost medical products, and combined with the increasing
penetration of e-commerce is driving the UK ePharmacy market growth. User penetration will be 83.1% in 2023 and
is expected to hit 86.3% by 2027
▪ A large patient pool globally prefers doorstep delivery of
healthcare products owing to unavailability of certain
medicines in retail pharmacy stores
▪ Additionally, ePharmacies lower the dependency of
chronically ill patients and elderly citizens towards third
person for procurement of medicines and healthcare
supplies. Additionally, the increasing penetration and literacy
regarding internet resources are projected to boost the
market sales.
▪ Please be aware that this sample report is intended to
provide you with a brief overview of the kind of information
and analysis that will be presented in the final report
▪ In order to obtain access to all of the information that you are
seeking, you will need to purchase the final report
▪ Final report will be comprehensive and detailed, and it will
include data, analysis, trends, and other relevant information
related to the topic or subject matter of interest
2010 2022 2030

34
3.2 Market restraints
3.2.1 In the UK, ePharmacies collect
and process user data, this user
data also make ePharmacies
vulnerable to data breaches and
cyberthreats
▪ To provide a flawless consumer
experience, these online
platforms rely substantially on
useful insights obtained from
user data (personal details,
purchasing habits, etc.)
▪ As a result, this data is
vulnerable to data breaches and
other cyberthreats.
3.2.2 In UK, there is currently no
unique or specific legislative
framework that solely governs the
operations and practices of
ePharmacies
▪ Owing to there is no unique
regime for these players, the
legal system that governs the
offline sale of pharmacies
equally applies to E-Pharmacy
▪ To safeguard the interests of
customers and to act as a
backbone in encouraging growth
in this sector, the government
must establish a separate
legislative framework for E-
Pharmacies in the near future
3.2.3 In UK, implementing robust
prescription verification systems
while maintaining privacy can be
a complex task
▪ Validating prescriptions and
ensuring they are genuine poses
a challenge for ePharmacies
▪ Verifying prescriptions online is
crucial to prevent misuse or
illegal distribution of medications.
Implementing robust prescription
verification systems while
maintaining privacy can be
complex
Our analysis will thoroughly investigate the key restraints that may significantly impact business operations and growth

4. Competitive Landscape

36
4.1 Major Market Share
▪ UK ePharmacy market is a highly
competitive space, with many companies
developing and marketing ePharmacy
treatments
▪ Some of the top companies in UK
ePharmacy market based on revenue and
market share include
interest
Revenue of Major players in UK ePharmacy Market ($ Mn)
XX
Company10
Company 1
Company 2
Company 3
Company 4
Company 5
Company 6
Company 7
Company 8
Company 9

37
4.2 Key Company Profile
▪ Here is the list of top 10 companies which
will cover in the final report
▪ Each company will have slides for
o Overview
o Key details
o Offerings
o Name of products
o Recent activities/ Press Coverage
o Distribution and Vendor Partners
o Mergers, Acquisitions and
Collaboration
o Financials
▪ If there are specific companies that you
would like to be included in the report,
please let us know via email
1 Pharmacy2u
3 Chemist4U
5 AYP Healthcare
7 Superdrug Online Doctor
9 Simple Online Pharmacy
2 LloydsPharmacy
4 The Independent
Pharmacy
6 Well Pharmacy
8 e-Surgery
MedExpress
10
Key Note:

38
4.2.1 Pharmacy2U
Founded in: 1999
HQ: Leeds, United Kingdom
Type: Private
Revenue: $150 Mn
Website: www.pharmacy2u.co.uk
▪ Pharmacy2U is one of the largest online pharmacies in the UK
▪ It operates as an online platform that provides a range of
healthcare services and products
▪ Pharmacy2U's primary focus is on providing convenient access to
prescription medications and healthcare advice to customers
across the country
▪ They operate under the supervision of the General
Pharmaceutical Council (GPhC) and follow guidelines set by the
Medicines and Healthcare products Regulatory Agency (MHRA)
Solutions offered by Roche
➢ Mark Livingstone - Chief
Executive Officer (CEO)
➢ Daniel Lee - Chief Financial
Officer (CFO)
➢ Julian Harrison - Chief
Commercial Officer (CCO)
➢ Andy Hornby - Chairman
Services Offered by Pharmacr2U
Online Prescription Ordering Medication Reminder Service
Repeat Prescription
Management
Online Doctor Consultations
NHS Prescription Service Health Information and Advice
Online Doctor Service NHS Prescriptions
Medication Delivery
ePharmacy Recent Activity / Press Coverage
April 2023, Pharmacy2U, the leading online pharmacy in the UK,
announced that they will be leveraging RingCentral’s UCaaS and
CCaaS services through the cloud, to offer next-level customer service
in the age of digital transformation
November 2022, Pharmacy2U Voted UK Number One Brand for
Customer Experience By Pharmacy2U

39
4.2.1 Pharmacy2U (continued)
Current Corporate Partners Current Clinical Trail Partners
Partnerships Ecosystem

40
Company Name Type
Amount /
Duration
Year Key Pointers
Pharmacy2U
partnership with
Diabetes UK
Merger -
October
2021
▪ Pharmacy2U announced new partnership with Diabetes UK
▪ This partnership aims to help support people currently living with
diabetes, as well as those at increased risk of type 2 diabetes
across the UK
▪ With 4.9 Mn people living in the UK with diabetes and an
estimated 13.6 million people at increased risk of developing type
2 diabetes, providing clear information and accessible guidance
is crucial
Latest Deals - Mergers and Acquisitions
Illustrative

41
63.3
70.3 70.9
2020 2021 2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2030F
Revenues ($Bn), 2020-2030
▪ Pharmacy2U annual revenue for 2022 was
$150 Mn, a xx% increase from 2021.
Pharmacy2U annual revenue for 2021 was
$xx, a xx% increase from 2020.
▪ Revenue generated by Pharmacy2U in
2022 reflects the company's continued
growth and success in the healthcare
industry
Breakdown of Net Revenue by Segment, 2022
1 2 3 4
Illustrative

42
4.2.2 Company 2
Founded in:
HQ:
Type:
Revenue:
Website:
Solutions offered by Company
Drugs Indications
Drugs for
ePharmacy
Recent Activity / Press Coverage
Illustrative

43
4.2.2 Company 2 (continued)
Major Distribution Partners Major Vendor Partners
Partnerships Ecosystem
Illustrative

44
Company Name Type
Amount /
Duration
Year Key Pointers
Latest Deals - Mergers and Acquisitions
Illustrative

45
xx xx xx
2020 2021 2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2030F
Revenues ($Bn), 2020-2030
▪ Please be aware that this sample report is
report
▪ In this section you will the understating of
financial overview of the company, which
includes revenue forecasting, segment
revenue and other key details as per
availability
interest
Breakdown of Net Revenue by Segment, 2022
1 2 3 4
Illustrative

5. Reimbursement Scenario

47
5.1 Reimbursement Regulation
The reimbursement scenario in the US ePharmacy market is complex and can
vary depending on the specific treatment, setting of care, and insurance
coverage. Here are some key points to consider:
▪ Medicare:
o Medicare is a federal health insurance program for people aged 65 and
older, as well as people with certain disabilities or health conditions
o Medicare covers many ePharmacy treatments, including chemotherapy,
radiation therapy, and some immunotherapies
o However, coverage can be subject to strict guidelines and restrictions,
such as the requirement for prior authorization
▪ Medicaid:
o Medicaid is a joint federal-state program that provides health insurance
for people with low incomes
o Medicaid coverage for ePharmacy treatments can vary by state, and
may be subject to limits on the amount and type of treatment covered
▪ Private Insurance:
o Private insurance coverage for ePharmacy treatments can also vary
widely depending on the insurer and the specific policy
o Some policies may have high out-of-pocket costs, such as deductibles
and co-pays, while others may have more comprehensive coverage
Medicare and Medicaid together provide
health insurance coverage for more than
4 in 10 Americans
Medicare
17%
Medicaid
and CHIP
21%
Employer-Sponsored
49%
Other Private
3%
Other Public
1%
Uninsured
9%
Health Insurance Coverage, 2022

48
5.1 Reimbursement Regulation (continued)
▪ Affordable Care Act:
o Affordable Care Act (ACA) includes provisions to help improve access to ePharmacy treatments by requiring insurers to
cover certain preventive services, including ePharmacy screenings, without co-pays or deductibles
o It also includes protections for people with pre-existing conditions, such as ePharmacy
▪ Reimbursement for New Treatments:
o Reimbursement for new ePharmacy treatments can be a complex and lengthy process, as insurers and government
programs often require evidence of safety and effectiveness before providing coverage
o This can create challenges for companies developing and marketing new treatments
▪ Value-Based Care:
o There is a growing trend towards value-based care, which aims to improve outcomes and lower costs by focusing on the
value of treatments rather than simply the volume of treatments
o Value-based care models can include payment models that tie reimbursement to outcomes or performance metrics
In order to obtain access to all of the information that you are seeking, you will need to purchase the final report
Final report will be comprehensive and detailed, and it will include data, analysis, trends, and other relevant information related to the
Illustrative

49
5.1 Reimbursement Regulation (continued)
Coverage Penetration (% Total Population) Source of Funding
Spend on Healthcare (%of Current Health Expenditure)
Reimbursement Market Trends
 Public healthcare coverage is provided by the government and includes programs like
Medicare and Medicaid
 Medicare is a federal program that provides healthcare coverage to individuals who
are 65 years of age or older, as well as certain younger people with disabilities
 Medicaid is a joint federal-state program that provides healthcare coverage to
individuals with low income and limited resources
▪ Shift towards value-based care has been a significant trend in the US healthcare system, with payers and providers increasingly focused on improving patient
outcomes and reducing costs
▪ This has led to the development of alternative payment models such as accountable care organizations (ACOs) and bundled payment arrangements, which
incentivize providers to deliver high-quality, cost-effective care 38.9%
37.1%
35.6%
32.5%
31.5%
44.0%
46.0%
47.7%
51.0%
51.8%
2017 2018 2019 2020 2021 2022 2023
Government Expenditure
Private Health Insurance
Out of Pocket
Other
NA NA
100% 100% 100% 100% 100%
xx xx xx xx xx
2012 2013 2014 2015 2016
Public Healthcare
Coverage
Private Coverage
6.3% 4.08% 5.1% 3.8% 2.2% 2.4% 3.6% GDP Growth (yoy)
14.7% 11.3% 15.5% 7.5% 4.2% NA NA HC Spend Growth (yoy)
Illustrative

50
5.2 Reimbursement Process
The reimbursement process in the US healthcare system can be complex and can vary depending on the type of healthcare service,
the healthcare provider, and the insurance coverage. Here are the general steps involved in the reimbursement process:
▪ Service or Treatment Provided: The healthcare provider performs a service or treatment for the patient
▪ Billing: The healthcare provider submits a claim to the insurance company or other payer, requesting reimbursement for the
service provided
▪ Adjudication: The insurance company or other payer reviews the claim to determine whether it meets the criteria for
reimbursement. This can involve verifying the patient's eligibility, reviewing the treatment provided, and checking for any potential
errors or fraud
▪ Payment: If the claim is approved, the insurance company or other payer reimburses the healthcare provider for the service
provided, based on the negotiated payment rates or fee schedule
▪ Patient Responsibility: Depending on the patient's insurance coverage, they may be responsible for paying a portion of the cost
of the service, such as deductibles, co-payments, or co-insurance
In order to obtain access to all of the information that you are seeking, you will need to purchase the final report
Final report will be comprehensive and detailed, and it will include data, analysis, trends, and other relevant information related to the
Illustrative

51
5.3 Reimbursement Process
The reimbursement process in the US healthcare system can be complex
and can vary depending on the type of healthcare service, the healthcare
provider, and the insurance coverage. Here are the general steps involved
in the reimbursement process:
▪ Service or Treatment Provided: The healthcare provider performs a
service or treatment for the patient
▪ Billing: The healthcare provider submits a claim to the insurance
company or other payer, requesting reimbursement for the service
provided
▪ Adjudication: The insurance company or other payer reviews the claim
to determine whether it meets the criteria for reimbursement. This can
involve verifying the patient's eligibility, reviewing the treatment
provided, and checking for any potential errors or fraud
▪ Payment: If the claim is approved, the insurance company or other
payer reimburses the healthcare provider for the service provided,
based on the negotiated payment rates or fee schedule
FDA
Private Payers Public Payers
Health Technology Assessment
Payment
Coverage
Coding
Coding depends on availability code while coverage and
payment process decisions are made through an HTA.
Market Authorization
1 3
2
Illustrative

52
5.4 Reimbursement Process - Medicare
Medicare
Population Covered
▪ 100% population is covered under this scheme
▪ Citizen’s contribute to this scheme which then earns an interest. There is Basic Healthcare Sum (BHS) cap which limits the maximum contribution to an
individuals Medicare account
Provider Restrictions/
Selection
Services can be claimed from Medicare-approved institutions only (14 public hospitals, 10 private hospitals, 7 public community centers, 1 private community
center and over 100 surgery centers, ePharmacy centers, colonoscopy centers and screening centers)
Services Covered
▪ Medicines under SDL and MAF Plus can be bought from the money saved in this account
▪ Money can be also be claimed for antiretroviral drugs for HIV, Desferrioxamine drug for treatment of thalassemia and immuno-suppressant drugs for organ
transplant
▪ Money from this account can be used to pay Medishield premiums and Integrated Shield Plan premiums, subject to withdrawal limits
▪ Patients above 65 years of age can claim under Flexi-Medicare and further reduce their out-of-pocket expenses by using up to $200 per patient per year from
their Medicare account
▪ Excluded: Traditional drugs such as Herbal and Ayurveda cannot be claimed from Medicare account; Drugs used for cosmetic purposes such as slimming pills
and hair loss pills cannot be claimed from this account
Level of Coverage/ Assurance
▪ Approved chronic conditions and vaccinations, health screenings as outpatient treatments can be paid with Medicare up to $500 per account per year, however
a cash copayment of 15% is applicable
▪ Inpatient hospitalization, up to $450 per day + surgical limits according to Table of Surgical Procedures
▪ Approved day surgeries up to $300 per day + surgical limits according to Table of Surgical Procedures
▪ Outpatient scans/ diagnostics for ePharmacy up to $600 per year per patient, and up to $300 for other medical conditions
▪ Chemotherapy (includes analgesic medication and suppressive treatments such as neuroendocrine and nuclear medicine treatments) up to $1,200 per month
per patient
▪ Renal ePharmacy up to $450 per patient per month
▪ Other treatments are also approved with various sub-limits for withdrawal
Mechanism of Coverage
▪ DRG with Activity Based Funding for public providers
▪ Block funding with DRG for providers not covered under ABF
Financial Feasibility ▪ The Basic Healthcare sum has been increased by more than 4.4% in 2017 on account of increasing costs of healthcare. This is an individual account
Illustrative

53
5.5 Reimbursement Process - Medicaid
Medicaid
Population Covered
▪ 38% population is covered under this scheme
▪ Medicare covers individuals who are aged 65 and older, as well as those with certain disabilities or end-stage renal disease
Provider Restrictions/
Selection
Services can be claimed from Medicaid-approved institutions only (14 public hospitals, 10 private hospitals, 7 public community centers, 1 private community
center and over 100 surgery centers, ePharmacy centers, colonoscopy centers and screening centers)
Services Covered
▪ Medicines under SDL and MAF Plus can be bought from the money saved in this account
▪ Money can be also be claimed for antiretroviral drugs for HIV, Desferrioxamine drug for treatment of thalassemia and immuno-suppressant drugs for organ
transplant
▪ Money from this account can be used to pay Medishield premiums and Integrated Shield Plan premiums, subject to withdrawal limits
▪ Patients above 65 years of age can claim under Flexi-Medicaid and further reduce their out-of-pocket expenses by using up to $200 per patient per year from
their Medicaid account
▪ Excluded: Traditional drugs such as Herbal and Ayurveda cannot be claimed from Medicaid account; Drugs used for cosmetic purposes such as slimming pills
and hair loss pills cannot be claimed from this account
Level of Coverage/ Assurance
▪ Approved chronic conditions and vaccinations, health screenings as outpatient treatments can be paid with Medicaid up to $500 per account per year, however
a cash copayment of 15% is applicable
▪ Inpatient hospitalization, up to $450 per day + surgical limits according to Table of Surgical Procedures
▪ Approved day surgeries up to $300 per day + surgical limits according to Table of Surgical Procedures
▪ Outpatient scans/ diagnostics for ePharmacy up to $600 per year per patient, and up to $300 for other medical conditions
▪ Chemotherapy (includes analgesic medication and suppressive treatments such as neuroendocrine and nuclear medicine treatments) up to $1,200 per month
per patient
▪ Renal ePharmacy up to $450 per patient per month
▪ Other treatments are also approved with various sub-limits for withdrawal
Mechanism of Coverage
▪ DRG with Activity Based Funding for public providers
▪ Block funding with DRG for providers not covered under ABF
Financial Feasibility ▪ The Basic Healthcare sum has been increased by more than 4.4% in 2017 on account of increasing costs of healthcare. This is an individual account
Illustrative

6. Methodology & Scope

Research Methodology
▪ Insights 10’s research methodology delves deeper into the market, covering the macro and micro aspects of the industry. We identify the
key growth drivers, opportunities, and restraints that might promote or hinder the future industry growth along with an expansive
overview of the competitive landscape to help our clients make informed strategic decisions
▪ We implement a mix of primary and secondary research for our market estimate and forecast. The secondary research forms the initial
phase of our study where we conduct extensive data mining, referring to verified data sources such as independent studies, government
and regulatory published material, technical journals, trade magazines, and paid data sources
▪ For forecasting, the following parameters are considered:
❑ Market drivers and restraints along with their current and expected impacts
❑ Technological scenario and expected developments
❑ End use industry trends and dynamics
❑ Trends in the consumer behavior
❑ Regulatory scenario and expected developments
❑ Current capacity and expected capacity additions up to 2030
▪ We assign weights to these parameters and quantify their market impacts using the weighted average analysis to derive the expected
market growth rate
▪ We appoint data triangulation strategies to explore different areas of the market. Our qualitative and quantitative assessments are time-
sensitive, reflecting the most recent value and volume of the market across regions
▪ All our estimates and forecasts are verified through exhaustive primary research with the Key Industry Participants (KIPs)
▪ Currency used in the report is the US dollar (USD), with the market size indicated in USD million/billion (Mn/Bn)

Analysis Methodology
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Revenue generated by products &
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Size
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Final Market size break up to
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Final
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Key Benefits for Stakeholders from this Report
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