The Increasing Influence of Payers, Providers, and Patients on the U.S. Pharmaceutical Market

Table of Contents

• Executive Summary
  • Strategic Considerations
  • Stakeholder Implications
• Introduction
• Payers
  • Formulary Negotiations
  • Rebates and Discounts
  • Increasing Cost Containment
    • Multitier Formularies
    • Patient Copayments and Coinsurance
    • Use of Generics
    • Prior Authorization and Step Therapy
• Providers
  • Physician Detailing
  • Professional Advertising
  • Sampling
• Patients
  • Direct-to-Consumer Advertising
  • The Internet
  • The Rise of Consumerism
• Outlook and Implications for the Pharmaceutical Industry

Sidebars

• A New Generation of Health Web Sites
• Encouraging Consumers to Take More Responsibility for Their Health Care

Tables

• 1. Frequency of Select Situations in Formulary Decision-Making
• 2. Importance of Select Factors in Managed Care Organizations' Formulary Decision-Making
• 3. U.S. Employers' Views Regarding Strategies to Increase Prescription Drug Benefit Value, 2005
• 4. Pros and Cons of Direct-to-Consumer Advertising
• 5. Key Features of Health Savings Accounts and Health Reimbursement Accounts

Figures

• 1. Managed Care Organizations' Desired Changes in Pharmacoeconomics
• 2. Mean Patient Copayments for Generics, Preferred Branded Medicines, Nonpreferred Branded Medicines, and Fourth-Tier Drugs, 2000-2006
• 3. Percentage of Covered Workers Required to Pay Copayments and/or Coinsurance, by Formulary Tier, 2006
• 4. Mean Patient Coinsurance Rates for Generics, Preferred Branded Medicines, Nonpreferred Branded Medicines, and Fourth-Tier Drugs, 2000-2006
• 5. Total U.S. Spending on Select Forms of Pharmaceutical Promotional Activity, 2002-2006
• 6. Percentage of Employers Offering Their Employees the Option of Enrollment in a Consumer-Directed Health Plan, 2004-2008 (projected)