世界の主要国における癌治療薬の政治・償還関連環境：主要動向

Abstract

Introduction

Cancer therapies make up one of the fastest-growing therapeutic areas in the global pharmaceutical market. IMS Health expects global sales of cancer therapies to more than double in just four years, exceeding $65 billion in 2010. Not surprisingly, the pharmaceutical industry is eager to tap the potential of this market. A critical factor in this growth, in both the United States and the European market, is the ever-evolving reimbursement environment-and the political trends that infl uence it.

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• Oncology drugs form one of the largest therapeutic areas of the global pharmaceutical market, with worldwide sales of almost $30 billion in 2006. What factors account for the success of this fast-growing market? How is the pharmaceutical industry responding to this growth?
• Increasingly restrictive reimbursement policies will continue to impose strict cost controls on cancer therapies. How will the U.S. Medicare system manage its funding policies? What changes are in store for cancer therapy reimbursements by commercial insurers? How will the new funding program in France affect its high rate of spending on cancer drugs? How will reform measures in Germany affect its reference pricing system. What changes are included in Italy' s new national health system? Will the U.K.' s new Cancer Reform Strategy affect spending on cancer drugs?
• The global market for oncology drugs will continue to grow vigorously in the coming years. Are the industry' s pricing strategies expected to change in the worldwide market? What strategies will pharmaceutical companies undertake to expedite the launch of new drugs in Europe?

Scope

• The fi ght against cancer is one of the highest healthcare priorities in all advanced economies: government funding systems; worldwide public and private reimbursement programs; payment policies for innovative cancer therapies.
• U.S. and European government insurance systems are all under pressure to rein in healthcare costs: reimbursement for cancer therapies is a target for cost cutting; offi ce-based cancer treatments create payment challenges for physicians; pharmaceutical companies need to establish an infrastructure for conducting price negotiations with payers.
• Health technology assessment (HTA) now infl uences a wide span of product life cycles: earlystage R&D affected by the demands of HTA; evidence of clinical effectiveness needed to defend a drug against the threat of price cuts.
• Illustrated fi gures: Percentages of private and Medicare plans that place restrictions on the use of select targeted cancer therapies.

Table of Contents

• Executive Summary
  • Strategic Considerations
  • Stakeholder Implications
• Introduction
• United States
  • Changes to Medicare Part D Coverage of Oncology Drugs
  • Impact of Changes to Medicare Part B Reimbursement
  • Reductions in Medicare Hospital Outpatient Reimbursement
  • Reimbursement Changes in the Private Sector
  • Infl uence of Physician Reimbursement on Prescribing Behavior
  • Coverage of Targeted Therapies
  • Cost-Containment Strategies
  • Patient Access to Innovative Therapies
  • Courts Reject Calls for Right of Access to Experimental Drugs
  • FDA Amendments Act
• France
  • Strong Growth in Spending on Oncology Drugs
  • Flexible Funding Arrangements for Innovative Drugs
  • Promoting Good Use of Cancer Therapies
• Germany
  • Prospect of Health Economic Evaluation and Reimbursement Limits for New Therapies
  • Interaction Between Hospitals and Primary Care
  • Disease Management Programs
  • Off-Label Prescribing
• Italy
  • Hospital Reimbursement
  • Financial Constraints
• Spain
  • Regional Variations in the Use of Innovative Therapies
  • National Cancer Strategy
  • Future Emphasis on Health Technology Assessment of New Drugs
• United Kingdom
  • Cancer Reform Strategy
  • NICE' s Impact on U.K. Oncology
  • Diffi culties of Combining Privately and Publicly Funded Treatment
  • Government Plans to Replace the Pharmaceutical Price Regulation Scheme
• Outlook and Implications for the Pharmaceutical Industry

Tables

• 1. Regional Variations in the Use of Select Targeted Cancer Therapies in Spain

Figures

• 1. U.S. Cancer Patients' Principal Sources of Health Insurance Coverage
• 2. Coverage of Select Targeted Cancer Therapies by Private Health Plan
• 3. Coverage of Select Targeted Cancer Therapies by Medicare Plans
• 4. Percentage of Private and Medicare Plans That Impose Prior Authorization on Select Targeted Cancer Therapies
• 5. Percentage of Private and Medicare Plans That Monitor Patient Response to Select Targeted Cancer Therapies
• 6. Percentage of Private and Medicare Plans That Impose Quantity Limits on Select Targeted Cancer Therapies
• 7. Percentage of Private and Medicare Plans That Require Patients to Obtain Select Targeted Cancer Therapies from Specialty Pharmacies
• 8. Percentage of Private and Medicare Plans That Impose No Cost Controls on the Use of Select Targeted Cancer Therapies

Sidebar

• Brown Bagging on the Increase in the United States