Pharmaceutical Distribution in the US: Current and Future Perspectives

Table of Contents

Executive Summary

Chapter 1: The US Pharmaceutical Supply Chain

• The pharmaceutical supply chain
• The US pharmaceutical industry
• The role of pharmaceuticals
• US pharmaceutical manufacturers
• Pharmaceutical Research and Manufacturers of America (PhRMA)
• The US biotech industry
• The Biotechnology Industry Organization (BIO)
• Case study: the pharmaceutical and biotech industries at a state level
• The US pharmaceutical market
• The US healthcare system
• Medicare and Medicaid
• State Children' s Health Insurance Program
• Pharmaceutical legal obligations
• Wholesale distribution
• The US wholesale market
• Primary wholesalers
• Secondary wholesalers
• Prescription Drug Marketing Act
• PDMA revisions
• The pedigree requirement
• State-level actions
• US pharmacy market
• Pricing freedom
• US pharmaceutical spending
• Pharmaceutical pricing issues in the US
• US consumer pricing studies
• Outlook for US biopharmaceutical R&D
• Average wholesale price and average sales price
• Internet trading
• Parallel trade

Chapter 2: The US Wholesale Sector

• Wholesaling in the US
• The Healthcare Distribution Management Association
• The National Coalition of Pharmaceutical Distributors
• Wholesaler consolidation
• Challenges to the dominance of the Big Three
• Case study: RxUSA launches legal challenges against the Big Three
• Cardinal Health Inc
• McKesson Corporation
• AmerisourceBergen Corporation
• Wholesaler technology solutions
• Electronic data interchange
• Collaborative planning, forecasting and replenishment
• Enterprise resource planning
• Order fulfilment packages
• Database technology
• Electronic point-of-sale technology
• Barcoding
• Case study: US highlights benefits of barcode and RFID technologies
• Costs and benefits of EPC/RFID implementation
• Warehouse technology
• Dispensing technology
• Future systems
• The US supply chain and direct distribution
• Development of direct distribution in Europe
• Rationale behind changes in the supply chain
• Challenges to direct distribution in the US
• US wholesalers and globalisation

Chapter 3: Pharmacy in the US

• The US pharmacy sector
• The American Pharmacists Association
• Case study: the AphA and medication therapy management
• The Academy of Managed Care Pharmacy
• Chain drug stores
  • Walgreens
  • CVS Caremark
• National Association of Chain Drug Stores
• Case study: the National Trust for Historic Preservation responds to chain drug stores
• Independent pharmacies
• National Community Pharmacists Association
• Mail-order pharmacies
• Online pharmacies
• Case study: PharmacyChecker.com
• Pharmacists and parallel trade
• OTC products
• Rx-to-OTC switching
• Pharmacists and OTCs
• Case study: US pharmacists and Rx-to-OTC switching of allergy products
• Pharmacy benefit managers
• The Pharmaceutical Care Management Association
• Case study: PBMs force patients to switch medications
• The future of US pharmacy
• Patient compliance
• Pharmacies and retail health clinics
• Case study: 2008 survey of patient use of retail health clinics
• Case study: Florida tightens pharmacy regulations
• Biogenerics
• Case study: biogenerics legislation restrictions for pharmacists
• Pharmacy groups launch Project Destiny

Chapter 4: Protecting the US Supply Chain

• Safeguarding the supply chain
• Disaster planning and the supply chain
• Alternative strategies for mass distribution of medicines
• Case study: US community pharmacies launch Rx History
• Case study: ICERx.org
• Product shortages in the supply chain
• The Food and Drug Administartion (FDA) and drug shortages
• Case study: vaccine shortages and the effect on the supply chain
• Counterfeiting
• Anti-counterfeiting cooperation
• Counterfeiting and the pharmaceutical industry
• FDA anti-counterfeiting measures
• FDA recommendations on combating counterfeits
• Case study: the FDA' s Counterfeit Alert Network
• Case study: AstraZeneca opts for mass serialisation to prevent counterfeiting
• Using nanotechnology to combat counterfeiting
• Case study: FDA Nanotechnology Task Force report

References

List of Tables

• Table 1.1 Types of manufacturer medicines
• Table 1.2 The four parts of Medicare
• Table 2.1 Cardinal Health corporate business units
• Table 2.2 McKesson corporate business units
• Table 2.3 AmerisourceBergen Corporation business segments
• Table 2.4 Overall risks of DTP identified by the OFT
• Table 2.5 Challenges for a US direct distribution model
• Table 3.1 Potential patient benefits of medication therapy management
• Table 3.2 Potential competitive advantages of mail-order pharmacies
• Table 3.3 PharmacyChecker.com classification of online pharmacies
• Table 3.4 Top five major players in the pharmacy/retail clinic sector
• Table 3.5 The four components of Project Destiny
• Table 4.1 The application of the HIPAA in emergency situations
• Table 4.2 Recommendations to improve mass distribution of medicines during an emergency through using the private sector
• Table 4.3 ICERx.org partnerships
• Table 4.4 Key areas of focus for the International Medical Products Anti-counterfeiting Taskforce (IMPACT)

List of Figures

• Figure 1.1 Outline of the traditional supply chain
• Figure 1.2 Global R&D expenditure
• Figure 1.3 Pharmaceutical revenues for major companies (2007)
• Figure 1.4 Pharmaceutical R&D for major companies (2007)
• Figure 1.5 Revenues for major biopharmaceutical companies (2007)
• Figure 1.6 R&D for major biopharmaceutical companies (2007)
• Figure 1.7 US pricing environment compared with Europe and Japan
• Figure 1.8 Ongoing US pharmaceutical R&D dominance
• Figure 1.9 Share of parallel imports in European pharmacy markets
• Figure 2.1 Annual revenues for Cardinal Health and subsidiaries
• Figure 2.2 Annual revenues for McKesson Corporation
• Figure 2.3 Annual revenues for AmerisourceBergen Corporation
• Figure 3.1 Annual revenues for Walgreens
• Figure 3.2 Annual revenues for CVS Caremark
• Figure 3.3 Average annual sales per US pharmacy location
• Figure 3.4 Staff costs as a percentage of US pharmacy operating expenses
• Figure 3.5 Online pharmacy price analysis for select brands
• Figure 3.6 Online pharmacy price analysis for select generics
• Figure 3.7 Flow of goods and payment in the US supply chain
• Figure 4.1 Counterfeit drug cases opened by the FDA