Pricing & Reimbursement in Emerging Markets: Analysis of Pricing Mechanisms and the Iinfluence of Public and Private Sector Health Insurance Provision

Date: August 1, 2010
Pages: 104
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US$ 3,835.00
Publisher: Business Insights
Report type: Strategic Report
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ID: PDBA0C787AAEN
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Pricing & Reimbursement in Emerging Markets: Analysis of Pricing Mechanisms and the Iinfluence 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, Turkey

Key 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 report

Each 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 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 urban areas.

The authorities in several emerging markets have been seeking ways to encourage a greater uptake of generics instead of expensive branded 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?
Pricing and reimbursement in emerging markets
Executive summary
Introduction
Brazil
China
India
Mexico
Russia
South Korea
Turkey

CHAPTER 1 INTRODUCTION

Summary
Recent historical perspective
Growth drivers
Access barriers
Key pricing and reimbursement factors
Reimbursement lists
Pricing methodology
Role played by distribution chain
Future outlook

CHAPTER 2 BRAZIL

Summary
Introduction
Public sector provision
Private sector provision
Reimbursement system
Pricing mechanism
Price revisions
Public sector discounts
Pricing in practice
Future outlook

CHAPTER 3 CHINA

Summary
Introduction
Public sector provision
Urban areas
Rural areas
Private sector provision
Reimbursement system
Essential Drugs List (EDL)
Reimbursement levels
Pricing mechanism
EDL pricing
Hospital margins
Future outlook

CHAPTER 4 INDIA

Summary
Introduction
Public sector provision
Private sector provision
Reimbursement system
Pricing mechanism
Price revisions
Distribution margins
Future outlook

CHAPTER 5 MEXICO

Summary
Introduction
Public sector provision
Private sector provision
Reimbursement system
Pricing mechanism
Public sector
Private sector
Future outlook
Growth factors
Further price pressure expected

CHAPTER 6 RUSSIA

Summary
Introduction
Public sector provision
Private sector provision
Reimbursement system
Pricing mechanism
DLO drugs
Non-DLO drugs
Impact of price controls
Future outlook

CHAPTER 7 SOUTH KOREA

Summary
Introduction
Public sector provision
Private sector provision
Reimbursement system
Pricing mechanism
Pricing dynamics
Future outlook

CHAPTER 8 TURKEY

Summary
Introduction
Public sector provision
Private sector provision
Reimbursement system
Prescribing practices
Pricing mechanism
Future outlook

APPENDIX

Methodology
Glossary

LIST OF FIGURES

Figure 2.1: Brazil: pharmaceutical sales, 2005-2009
Figure 2.2: Brazil: private health insurance turnover, 2003–2009
Figure 4.3: India: price structure for price-controlled formulations
Figure 5.4: Mexico: number of affiliates of healthcare schemes, 2009
Figure 7.5: South Korea: organizational structure of NHI system
Figure 8.6: Turkey: breakdown of generic/originator products available on market

LIST OF TABLES

Table 1.1: Emerging markets: per capita spend on pharmaceuticals, 2008
Table 1.2: Emerging markets in global context: health expenditure ratios, 2000–2007
Table 2.3: Brazil: average drug price by medicine type, 2007–2008
TABLE 4.4: India: List of scheduled bulk drugs (DPCO 1995)
Table 5.5: Mexico: provisional health budget by sector, 2010
Table 8.6: Turkey: distribution margins for drugs
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