Improving Outlook in the U.S. Market is Due to Specialty Product Opportunities and Broader Patient Access with Implementation of the Affordable Care Act and Expansion of Medicaid

August 13, 2014

Outcomes-Based Approaches by Payers May Support Value Messaging for Pharmaceuticals, According to Findings from Decision Resources Group

BURLINGTON, Mass., Aug. 13, 2014 /PRNewswire/ — Decision Resources Group finds that the outlook for the pharmaceutical market in the United States is becoming more favorable, as the size of the insured population is expanding and opportunities for specialty pharmaceutical products support premium pricing and better profitability. The implementation of the Affordable Care Act appears to be expanding patient access, as mandated enrollment through the state and federal health insurance exchanges has outpaced government estimates. In addition, the majority of states have expanded their Medicaid programs according to this law (or are proposing alternative programs).


Other key findings from the United States Market Access Tracker advisory service:

    --  Healthcare reform reducing the ranks of the uninsured: The Affordable
        Care Act exceeded government expectations with the enrollment of 8
        million people through federal and state health insurance exchanges. The
        expansion of Medicaid coverage at the state level has further reduced
        the ranks of the uninsured with 26 states (and the District of Colombia)
        expanding coverage, while 21 states have decided not to expand this
        program, and four states remain undecided or are proposing alternative
    --  New model for providers and payers: Accountable Care Organizations
        (ACOs) were established to better align patient, provider and payer
        interests with financial incentives for meeting performance standards
        and specific levels of savings. The number of Medicare and commercial
        ACOs has greatly exceeded expectations in terms of both number of plans
        and covered lives.
    --  Increase of comparative effectiveness research (CER): CER will play an
        increasingly important role in reimbursement decisions in the United
        States. AMCP's Format for Formulary Submissions includes CER guidelines
        in its standards for formulary submissions, and the Patient-Centered
        Outcomes Research Institute was established under the Affordable Care
        Act to promote CER in evaluating new drugs.
    --  Value-Based Purchasing: The American Hospital Association is promoting
        new operating methods to support value-based payment initiatives that
        are more focused on patient outcomes, population health management and a
        coordinated care approach, while moving away from providing volume-based

Comments from Decision Resources Group Analyst Michael Latwis, M.B.A.:

    --  "Government and private payers are exploring new models that put greater
        emphasis on disease prevention and improving the quality of healthcare
        services. This shift could be an advantage for the pharmaceutical
        industry if companies can demonstrate that their products can improve
        outcomes and reduce overall healthcare expenditures."
    --  "Many companies are focusing their strategies on higher-priced specialty
        pharmaceutical products to help their businesses recover from the severe
        generic erosion experienced over the past several years. Regulatory
        reforms like Breakthrough Therapy Designation have helped accelerate
        clinical development timelines for innovative pharmaceutical products,
        while recent orphan drug legislation has become more accommodative by
        expanding exclusivity periods for drugs that treat multiple indications
        (that may put them over the 200,000 patient threshold) or contain new
        delivery formulations."

About Decision Resources Group

Decision Resources Group offers best-in-class, high-value information and insights on critical issues within the healthcare industry. Clients rely on this analysis and data to make informed decisions. Find out more at www.DecisionResourcesGroup.com.

All company, brand, or product names contained in this document may be trademarks or

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For more information, contact:

Decision Resources Group

Christopher Comfort



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SOURCE Decision Resources Group

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