PharmaSphere: US Healthcare Policy Update - Impact Analysis of the Affordable Care Act on Stakeholders

Summary

GlobalData’s "PharmaSphere: US Healthcare Policy Update - Impact Analysis of the Affordable Care Act on Stakeholders" report provides essential information and analysis on the Affordable Care Act (ACA). GlobalData provides an in-depth analysis of the most significant provisions of the Act, which is expected to alter the landscape of the US healthcare system considerably. The report discusses the timeline of the ACA’s provisions as well as the potential impact of these provisions on various stakeholders in the US healthcare system including payers, providers, and pharmaceutical companies. Furthermore, the report analyzes current trends as various stakeholders position themselves to benefit from the ongoing healthcare reform in the US. The report also provides an outlook on what to expect with the full implementation of the provisions of the ACA.



Throughout the report, GlobalData’s analysts provide you with expert insight, expanding on each provision, strategy, and factor discussed, with the aim of providing you with the tools needed for making informed business decisions in a rapidly changing US healthcare system.

Highlights

Key Questions Answered

- What provisions of the ACA are coming into effect on January 1, 2014?
- What are the implications of the ACA on the payers, providers, pharmaceutical companies, and patients?
- In which therapeutic areas are companies more likely to benefit from the ACA?
- What is the forecast for prescription drug spending in the US through 2021?
- How will pharmacies position themselves to reap the benefits of the ACA’s provisions, particularly with the provisions coming into effect in January 2014?
- Are there potential healthcare access issues due to the ACA’s provisions?

About the Report

GlobalData’s PharmaSphere: US Healthcare Policy Update – Impact Analysis of the Affordable Care Act on Stakeholders report is an essential source of information and analysis on the ACA. GlobalData provides an in-depth analysis of the impact of the ACA on various stakeholders within the US healthcare system, including payers, providers, and pharmaceutical companies. The report discusses key provisions of the Act which are expected to significantly alter the shape of US healthcare. Furthermore, it provides valuable insight on emerging trends as well as potential strategies that are expected to be explored by stakeholders to enable them benefit from these provisions.

Reasons to buy

- The report provides a timeline of the ACA provisions and the potential impact on various stakeholders in the US healthcare system including providers, payers, and pharmaceutical companies
- The report discusses the dynamics of the US pharmaceutical industry including generics, biosimilars, and the Food and Drug Administration Safety and Innovation Act (FDASIA) of 2012
- The report contains expert insights on the strategies being used by these stakeholders to ensure that they benefit significantly from the implementation of the ACA’s provisions
- The report includes an outlook on future trends that are expected in the US healthcare system due to impact of the ACA

Table Of Contents

Table of Contents

1 Table of Contents 6
1.1 List of Tables 8
1.2 List of Figures 9
2 Introduction 10
2.1 Report Scope 10
2.2 Upcoming Related Reports 11
2.3 Recently Published Reports 11
3 Industry Dynamics 12
3.1 Soaring Expenditures in the US Healthcare System 12
3.1.1 US Healthcare Spending and Funding: Following the Healthcare Dollars 15
3.1.2 Generics: A Cost-Effective Option 20
3.2 Biosimilars: Proponents and Opponents 21
3.2.1 State Legislative Tussles 21
3.3 The Food and Drug Administration Safety and Innovation Act (FDASIA) of 2012 23
4 US Healthcare Reform 24
4.1 Overview 24
4.2 The Individual Mandate Provision 25
4.2.1 The US Supreme Court Ruling 26
4.3 Affordable Care Act Implementation Timeline 27
4.3.1 2010: Provisions Primarily Targeted at Increasing Healthcare Coverage 27
4.3.2 2011: Additional Rebates for Pharma 31
4.3.3 2012: The Emergence of Accountable Care Organizations 35
4.3.4 What’s New in 2013? 37
4.3.5 Beyond 2013 (2014-2018) 39
5 Stakeholders’ Analysis 42
5.1 Budgetary Impact of Insurance Coverage Provisions in the Affordable Care Act 42
5.2 Providers 45
5.2.1 Medicaid Expansion will increase Patient Volume 45
5.2.2 Looming Healthcare Access Problems? 48
5.2.3 Potential Increase in Quality of Healthcare Services 50
5.3 Payers 51
5.3.1 Increase in Member Volume by Insurance Exchanges 53
5.3.2 New Taxes and Industry Fees on Health Insurance Payers 54
5.3.3 Tiered-Provider Networks Continue to Be a Cost-Containment Strategy 55
5.4 Pharmaceutical Manufacturers 56
5.4.1 The Affordable Care Act: What’s in it for Pharmaceutical Manufacturers? 58
5.4.2 Prescription Drug Spending Will Grow to over $480 Billion by 2021 62
6 Strategic Outlook: The Way Forward 66
6.1 Obamacare Will Get “Rolling” Evaluation 66
6.2 Significant Shuttling Expected within Health Insurance Plans 67
6.3 The Pie Gets Even Bigger for Pharmaceutical Companies 67
6.4 Pharmacies Will Cash-in on Obamacare 69
7 Appendix 70
7.1 Bibliography 70
7.2 Abbreviations 74
7.3 Research Methodology 77
7.3.1 Coverage 77
7.3.2 Secondary Research 77
7.3.3 Expert Panel Validation 78
7.4 About the Authors 79
7.4.1 Analyst 79
7.4.2 Director of Healthcare Industry Dynamics 79
7.4.3 Global Director of Epidemiology and Health Policy 80
7.4.4 Global Head of Healthcare 80
7.5 About the Industry Dynamics Team 81
7.6 About GlobalData 81
7.7 Disclosure Information 81
7.8 Disclaimer 82



List of Tables

Table 1: Federal Medical Assistance Percentage for States with Newly Enrolled Medicaid Members 25
Table 2: Provisions of the Affordable Care Act Implemented in 2010 28
Table 3: Provisions of the Affordable Care Act Implemented in 2011 32
Table 4: Provisions of the Affordable Care Act Implemented in 2012 36
Table 5: Provisions of the Affordable Care Act Implemented in 2013 38
Table 6: Provisions of the Affordable Care Act to be Implemented in 2014-2018 40
Table 7: Estimate of Budgetary Effects of Coverage Provisions in the Affordable Care Act 43
Table 8: Annual Fees to be Generated from Health Insurance Providers from 2014 54
Table 9: Planned Reduction in Medicare Part D Coinsurance Rate for Branded and Generic Drugs, 2013-2020 60
Table 10: Annual Fees to Be Generated from Branded Drug Companies, 2012-2019 61



List of Figures

Figure 1: US Healthcare Expenditures and GDP, 2003-2012 13
Figure 2: US Per Capita Healthcare Expenditures and GDP, 2003-2012 14
Figure 3: US Personal Healthcare Spending by Service/Product, 2012 16
Figure 4: US Personal Healthcare Spending by Service/Product,1 2013-2021 17
Figure 5: US Healthcare Spending by Source of Funding,1 2012 19
Figure 6: US Healthcare Spending by Source of Funding,1 2010-2012 20
Figure 7: State Positions on Medicaid Expansion1 46
Figure 8: Timeline of Affordable Care Act Provisions Impacting Providers 47
Figure 9: Timeline of Affordable Care Act Provisions Impacting Payers 52
Figure 10: Domestic Exports of Pharmaceutical Products from the US, 1996-2011 57
Figure 11: Timeline of Affordable Care Act Provisions Impacting Pharmaceutical Companies 59
Figure 12: US Expenditures (Historical and Forecast) on Medicinal Products,1 2011-2021 63
Figure 13: Prescription Drug Expenditures,1 2011-2021 64
Figure 14: Prescription Drug Expenditures in the US (with and without the Affordable Care Act), 2011-2021 68

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