Healthcare reform and the mandate for insurance coverage for all US citizens would appear to represent new growth opportunities for the pharmaceutical industry. This can be true for pharmaceutical companies that begin to adapt to the realities of this evolving new healthcare market. Nothing in the current legislation seems to be dramatically different than what has been discussed and debated now for months….no surprises. Also, keep in mind, the plan will take years to unfold and become a reality. That doesn’t mean pharmaceutical companies can or should wait. In fact, the evolving new market will mean significant changes will be necessary to the traditional pharmaceutical business model which will also take time for companies to implement and execute.
Despite the upsides of potentially more than 30 million new prescription drug customers and the closing of the doughnut hole for seniors, here are some implications the industry must prepare for:
- The market for prescription drugs will progressively change from healthcare providers and patients to payers, insurers, and managed plans
- Payers (insurance companies and government/CMS programs) will have to become increasingly cost conscious to ensure sustainable affordability of the reform
- Generic drugs will become the workhorse for prescription drug plans, including being used in place of branded products that fail to demonstrate meaningful clinical benefits over generic drug options
- There will be tremendous cost saving incentives for the market to push for and demand a clear regulatory path for generic biologics/biosimilar drugs
- To secure premium pricing, newly launched branded pharmaceuticals will have to meet an even higher standard for proving their value over other therapeutic options, including generic drugs
- Information technology, including e-prescribing, will be employed to a much greater extent to help manage compliance with drug formularies and control costs.
- Traditional sales and marketing will have less influence on product availability at the prescription drug plan level and even less influence on physician prescribing practices
Pharmaceutical companies that anticipate these new dynamics can make the necessary adjustments and determine what they need to do to remain competitive in this evolving new healthcare market. More on what to do in the next posting.