Impact of US Healthcare Reforms - the Extension of Care to 32 Million Uninsured Citizens from 2014 and Implications for the Pharmaceutical Industry


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87pages

GBI Research

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GBI Research has released its latest report, Impact of US Healthcare Reforms - the Extension of Care to 32 Million Uninsured Citizens from 2014 and Implications for the Pharmaceutical Industry that provides key data, information and analysis of the US healthcare reforms and their impact. 

This report offers a comprehensive insight into the provisions and the impact of the US healthcare reforms. It provides an overview of the US healthcare system and establishes the need for healthcare reforms in the US. It talks in detail about the major provisions of the US healthcare reforms and briefly discusses their implications. It also offers the timeline for the implementation for the major provisions of the US healthcare reforms. Finally it discusses the impact of the US healthcare reforms on various stakeholders including the US government, the health insurance industry, the pharmaceutical and biotechnology industry, the hospitals and the employers. 

The report is based on proprietary databases, primary and secondary research and in-house analysis by GBI Researchs team of industry experts to provide a comprehensive view of the impact of the US healthcare reforms. 

Scope

The scope of the report includes - 

  • Overview of the US healthcare system
  • Major provisions of the US healthcare reforms and their impact
  • Impact of the US healthcare reforms on stakeholders including the US government, the health insurance industry, the pharmaceutical industry and the employers.

Reasons to buy

The report will enhance your decision making capabilities. It will allow you to - 

  • Make more informed business decisions from the insightful and in-depth analysis of the US healthcare reforms and their impact on the stakeholders.
  • Identify the opportunities and challenges presented by the US healthcare reforms.
  • Build effective strategies to launch the pipeline products by identifying potential segments in the US healthcare market.
  • Identify the opportunities for collaboration with the participants in the US healthcare system to develop innovative delivery models for enhancement of value for every stakeholder in the value chain
Table of Contents

1 Table of Contents

1 Table of Contents 3
1.1 List of Tables 5
1.2 List of Figures 6

2 Impact of Healthcare Reforms on the Pharmaceutical Industry Introduction 7
2.1 GBI Research Report Guidance 7

3 The US Healthcare System 8
3.1 Healthcare Facilities and Skilled Manpower 9
3.1.1 Healthcare Providers 9
3.1.2 Hospital Beds 10
3.1.3 Healthcare Professionals 11
3.2 Manufacturers and Marketers of the Pharmaceutical Products 12
3.3 Education and Research Institutes 13
3.4 Healthcare Funding Mechanism 14
3.4.1 Private Health Insurance Providers 15
3.4.2 Public Health Insurance Providers 15
3.4.3 Break Down of National Health Expenditure 17
3.5 Government and Regulatory Authorities in the Healthcare System 18
3.5.1 Department of Health and Human Services 18
3.5.2 The Food and Drug Administration 19
3.5.3 Centers for Disease Control 19
3.5.4 Agency for Healthcare Research and Quality 19
3.5.5 State Department of Health Services 19
3.5.6 Centers for Medicare and Medicaid Services 19
3.5.7 State Insurance Commissioners and National Association of Insurance Commissioners 20
3.6 Types of Healthcare Service 20
3.6.1 Primary Care 20
3.6.2 Secondary Care 20
3.6.3 Tertiary Care 20

4 The Need for Healthcare Reforms in the US 21
4.1 Low Overall Performance of the US Healthcare System 21
4.2 Rising Healthcare Expenditure in the US 23
4.3 Increase in the Health Insurance Premiums 26
4.4 Rise in the Contribution of Prescription Drugs to the NHE 28

5 Major Provisions of the US Healthcare Reforms 30
5.1 Introduction 30
5.2 Major Provisions 31
5.2.1 Health Insurance Reforms 31
5.2.2 Increased Health Insurance Coverage 37
5.2.3 Medicaid Drug Rebate Program Reform 44
5.2.4 Medicare Related Measures 45
5.2.5 Provisions for Comparative Effectiveness Research 53
5.2.6 Establishment of the Biosimilar Approval Pathway 54
5.2.7 Fee from the Healthcare Industry 62
5.2.8 Tax Related Measures 63
5.2.9 Provisions that Impact Primary Healthcare 65
5.2.10 Research-Related Provisions 66
5.2.11 Provisions Against Fraud and Abuse 68
5.2.12 Provisions Related to Transparency 69

6 Timelines for Implementation 70

7 Analysis of Impact on Major Stakeholders 74

7.1 The US Government 74
7.2 Impact on Insurers 75
7.2.1 Increased Coverage for Health insurance 75
7.2.2 Impact of Annual Fee 75
7.2.3 Impact of Medicare Advantage Plan Payment Cuts 75
7.2.4 Increase in Insurance Premiums 76
7.2.5 MLR-Based Regulation 76
7.2.6 Impact on Insurance Brokers and Agents 76
7.3 Impact on the Pharmaceutical Industry 76
7.3.1 Pharmaceutical Companies to Gain from Increased Insurance Coverage 78
7.3.2 Impact of the Annual Fee on the Pharmaceutical Companies 79
7.3.3 Impact of Closure of the Donut Hole 80
7.3.4 Impact of Medicaid Price Rebates 80
7.3.5 Biosimilar Legislation 80
7.3.6 No Provision for Pay-for-Delay Ban 81
7.3.7 Increase in the M&A and Licensing Activity 81
7.3.8 Increase in Outsourcing 81
7.3.9 Impact of Comparative Effectiveness Research Related Provisions 81
7.4 Impact on Employers 82
7.4.1 Small Businesses 82
7.4.2 Medium and Large Sized Businesses 82
7.5 Impact on Hospitals 82
7.6 Impact on Medical Equipment Providers 82

8 Impact of the US Healthcare Reforms Appendix 83
8.1 Market Definitions 83
8.2 Abbreviations 83
8.3 Research Methodology 85
8.3.1 Coverage 85
8.3.2 Secondary Research 85
8.3.3 Primary Research 86
8.3.4 Expert Panel Validation 86
8.4 Contact Us 86
8.5 Disclaimer 86
8.6 Sources 87
Table 1: Healthcare Reforms, The US, Healthcare Providers, 2008 9
Table 2: Healthcare Reforms, The US, Community Hospitals by Bed Distribution, 20062008 10
Table 3: Healthcare Reforms, The US, Number of Healthcare Professionals, 2008 11
Table 4: Healthcare Reforms, The US, Uninsured Residents, Millions and %, 19882009 22
Table 5: Healthcare Reforms, The US, Estimated Proportion of Population with a Pre-Existing Condition, %, 2009 32
Table 6: Healthcare Reforms, The US, Penalty on the Uninsured Individuals, $, 20142016 38
Table 7: Healthcare Reforms, The US, Estimates of Direct Expenditure on State Insurance Exchanges, $bn, 20122021 43
Table 8: Healthcare Reforms, The US, Reduction in Medicare Spending due to Readmissions, $m, 20132019 52
Table 9: Healthcare Reforms, The US, Biosimilar Market, Market Forecasts, $m, 20092016 56
Table 10: Healthcare Reforms, The US, Annual Fee on Branded Prescription Drug Manufacturers, $bn, 2011-2019 62
Table 11: Healthcare Reforms, the US, Annual Fee from the Insurance Industry, $bn, 20142019 63
Table 12: Healthcare Reforms, The US, Timeline of Provisions, 20102011 70
Table 13: Healthcare Reforms, The US, Timeline of Provisions, 20122013 71
Table 14: Healthcare Reforms, The US, Timeline of Provisions, 2014 72
Table 15: Healthcare Reforms, The US, Timeline of Provisions, 20152018 73
Figure 1: Healthcare Reforms, The US, Components of the Healthcare System, 2011 8
Figure 2: Healthcare Reforms, The US, Community Hospitals by Bed Distribution, %, 20062008 11
Figure 3: Healthcare Reforms, The US, Healthcare Research Expenditure, $bn, 19952009 13
Figure 4: Healthcare Reforms, The US, Flow of Funds in the Healthcare System, 2011 14
Figure 5: Healthcare Reforms, The US, Types of Health Insurance Plans, Public Versus Private, 2009 15
Figure 6: Healthcare Reforms, The US, National Health Expenditure Shares, %, 2009 17
Figure 7: Healthcare Reforms, The US, Healthcare Regulators, 2009 18
Figure 8: Healthcare Reforms, The US, Benchmarking of Healthcare Systems, 2010 21
Figure 9: Healthcare Expenditure as a Proportion of the GDP, Major Pharmaceutical Markets, %,19802007 23
Figure 10: Healthcare Reforms, The US, Increase in Per-capita Healthcare Expenditure, $,
19902019 24
Figure 11: Healthcare Reforms, Comparison of Spending on Healthcare, 19852008 24
Figure 12: Healthcare Reforms, The US, Increase in Insurance Premiums, %, 2010 26
Figure 13: Healthcare Reforms, The US, High Per-Capita Insurance Overheads $, 2009 27
Figure 14: Healthcare Reforms, The US, Year-on-Year Growth in Major Components of Healthcare, %, 19952009 28
Figure 15: Healthcare Reforms, The US, Proportion of Out-of-Pocket Expenditure for Prescription Drugs, %, 19602009 29
Figure 16: Healthcare Reforms, The US, Funding for the Healthcare Reforms, $bn, 20102019 30
Figure 17: Healthcare Reforms, The US, Estimates of People with Pre-existing Condition, Millions, 2009 32
Figure 18: Healthcare Reforms, The US, Provisions of the Employer Mandate, 2014 39
Figure 19: Healthcare Reforms, The US, Enrollment in the State Insurance Exchanges, millions, 20122021 42
Figure 20: Healthcare Reforms, The US, Estimates of Direct Expenditure on State Insurance Exchanges, $bn, 20122021 43
Figure 21: Healthcare Reforms, The US, Break Down of Additional Medicare Spending, %,
20102019 45
Figure 22: Healthcare Reforms, The US, Break Down of Medicare Savings, %, 20102019 46
Figure 23: Healthcare Reforms, The US, Medicare Part D Plan Structure, 2010 47
Figure 24: Healthcare Reforms, The US, Closure of Medicare Part D Coverage Gap for Brand-Name Drugs, 20102020 48
Figure 25: Healthcare Reforms, Closure of Medicare Part D Coverage Gap for Generic Drugs, 2010-2020 49
Figure 26: Healthcare Reforms, The US, Rise in Medicare Spending, $bn, 20002009 50
Figure 27: Healthcare Reforms, The US, Biosimilar Market, Market Forecasts, $m, 20092016 56
Figure 28: Healthcare Reforms, The US, Biosimilar Approval Pathway, Patent Litigation Provisions in the BPCIA Round 1, 2010 58
Figure 29: Healthcare Reforms, The US, Biosimilar Approval Pathway, Patent Litigation Provisions in BPCIA Round 2, 2010 60
Figure 30: Healthcare Reforms, The US, Impact of Tax on High-Value Healthcare Plans, $, 2018 64
Figure 31: Healthcare Reforms, The US, Reduction in the Expected NHE, $bn, 20092019 74
Figure 32: Healthcare Reforms, The US, Expected Reduction in the Medicare Spending, $bn, 20092019 75
Figure 33: Healthcare Reform, The US, Dependence on the US for Major Pharmaceutical Companies, %, 2009 77
Figure 34: Healthcare Reforms, The US, Decrease in the Number of Uninsured Non-elderly Due to Healthcare Reforms, million, 20102019 78
Figure 35: Healthcare Reforms, the US, Uninsured Population Split by Age, %, 2009 79