The Complexity of Pharmaceutical Prices: An Economic Analysis

2019 ◽  
Vol 24 (4) ◽  
Author(s):  
Erwin Blackstone ◽  
Joseph Fuhr Jr.
Keyword(s):  
Patent Protection ◽  
Insurance Companies ◽  
Market Work ◽  
Pharmaceutical Pricing ◽  
Pharmaceutical Firms ◽  
Generic Market ◽  
Substantial Risk ◽  
Pharmaceutical Prices ◽  
List Prices

This article examines the complexity of pharmaceutical pricing. Specifically, list prices are often considerably higher than net prices. PBMs have considerable market power to obtain substantial discounts (rebates) from pharmaceutical companies which encourages higher list prices. In general the generic market work well. At issue is how much of the discounts are passed on to other stakeholders. High prices during market exclusivity or patent protection encourages R&D. Pharmaceuticals spend a large percentage of revenues on R&D, earn large profits which are somewhat overstated and take substantial risk. Many firms never make a profit. Drugs provide great value and increase the quality of life of patients. Since subscribers often change insurance companies, insurers have a shorter time horizon than pharmaceutical firms, which could lead to coverage issues. Policies to mitigate high drug prices include changes to PBM rebate practices, stricter patent approvals and reduction of barriers for generics and biosimilars.

Professional dilemmas for caregivers in Turkish home care settings in Germany

2014 ◽  
Vol 1 (1) ◽  
pp. 47-56 ◽  
Author(s):  
Jan Basche
Keyword(s):  
Healthcare Services ◽  
Insurance Companies ◽  
Or Education ◽  
Migrant Communities ◽  
Caregiver Relationship ◽  
International Nursing ◽  
Nursing Literature ◽  
Intercultural Care ◽  
The Given

While calling for culturally sensitive healthcare services in migrant communities, the international nursing literature on intercultural care predominantly describes nursing staff as lacking cultural competences and immigrant customers as lacking cleverness to navigate the labyrinths of national healthcare systems. Congruences in language, culture and religion in the customer-caregiver relationship can decisively improve the quality of care. However, they do not automatically guarantee smooth working processes in monocultural in-home settings. On the contrary, new problems occur here for Turkish caregivers which are unknown to the legions of native professionals who feel challenged by migrants and which go beyond differences such as age, sex, income or education. While no cultural or religious brokering is necessary between customers and personnel in the given context in Germany, new challenges arise when caregivers are expected to legally broker between customers and insurance companies or doctors. Conflicting expectations of customers and management as well as their own colliding social and professional roles put the caregivers in a quandary and must be competently managed.

How the United Kingdom Controls Pharmaceutical Prices and Spending: Learning From Its Experience

2021 ◽  
pp. 002073142199709
Author(s):  
Marc A. Rodwin
Keyword(s):  
United Kingdom ◽  
Cost Effective ◽  
Market Prices ◽  
The United Kingdom ◽  
Generic Market ◽  
Pharmaceutical Spending ◽  
The Difference ◽  
The Government ◽  
Pharmaceutical Prices ◽  
Limit Access

To control costs and improve access, nations can adopt strategies employed in the United Kingdom to control pharmaceutical prices and spending. Current policy evolved from a system created in 1957 that allowed manufacturers to set launch prices, capped manufacturers’ rates of return, and later cut list prices. These policies did not effectively control spending and had limited effects on purchase prices. The United Kingdom currently controls pharmaceutical spending in 4 ways. (a) Since 1999, it has typically paid no more than is cost-effective. (b) Since 2017, for medicines that will have a significant budget impact, National Health Service England seeks discounts from cost-effective prices or seeks to limit access for 2 years to patients with the greatest need. (c) Since 2014, statutes and a voluntary scheme have required branded manufacturers to pay the government rebates to recoup the difference between the global pharmaceutical budget and actual spending. (d) For hospitals, generics and some patented drugs are procured through competitive bidding; community pharmacies are reimbursed through a system that provides an incentive to beat average generic market prices. These policies controlled the growth of spending, with the largest effects following budget controls in 2014. Changes since 2008 have reduced savings, first by paying more than is cost-effective for cancer drugs and then by applying higher cost-effectiveness thresholds for some drugs used to treat cancer and certain other drugs.

Enterprise risk management and Solvency II: the system of governance and the Own Risk and Solvency Assessment

2020 ◽  
Vol 21 (4) ◽  
pp. 317-332 ◽  
Author(s):  
Pablo Durán Santomil ◽  
Luis Otero González
Keyword(s):  
Risk Management ◽  
Insurance Industry ◽  
Solvency Ii ◽  
Enterprise Risk Management ◽  
Insurance Companies ◽  
Legal Form ◽  
Content Type ◽  
Enterprise Risk ◽  
Solvency Assessment

Purpose The purpose of this paper is to analyze how enterprise risk management (ERM), the system of governance and the Own Risk and Solvency Assessment (ORSA) have been boosted with the entry of Solvency II. Design/methodology/approach For this analysis, the authors have undertaken a survey of chief risk officers (CROs) working in Spanish insurance companies. Findings The results show that Solvency II has definitely promoted ERM in the European insurance industry and improved the system of governance of the insurance companies, and that the perceived value of the ORSA for the companies is higher than the cost. It is clear that the quality of ERM implemented by companies is higher in those that face more complex risks and with greater interdependencies – that is, larger companies, foreign insurers and insurers with several lines of business – but is unaffected by the legal form of the entity (mutual/corporation). Originality/value This study conducts primary research with surveys of CROs and develops a measure of the quality of ERM implemented by insurance companies.

scholarly journals Corporate Social Responsibility (CSR) of Innovative Pharmaceutical Corporations. The Case of BIOGEN

2018 ◽  
Vol 21 (3) ◽  
pp. 45-62 ◽  
Author(s):  
Janina Witkowska
Keyword(s):  
Corporate Social Responsibility ◽  
Pharmaceutical Industry ◽  
Social Responsibility ◽  
Corporate Philanthropy ◽  
Developed Countries ◽  
Orphan Drugs ◽  
Pharmaceutical Firms ◽  
Life Saving ◽  
Corporate Social

The aim of this paper is to discuss the common features and specificity of Corporate Social Responsibility (CSR) practices of innovative transnational corporations (TNCs) acting in the pharmaceutical industry. The innovativeness of pharmaceutical firms is understood here as their ability to make a breakthrough in the treatment of rare, incurable diseases. The examination of the issue leads to the conclusion that the specificity of CSR in this industry is related to the contradiction between the economic and social/ethical aspects of innovation processes in this field. A key issue of CSR in the innovative pharmaceutical industry seems to be the pricing of drugs, especially orphan and ultra‑orphan drugs, resulting in patients from less developed countries having limited access to life‑saving medicines or those that improve the quality of life. Corporations use their monopolistic position to set extremely high prices. However, without the market/marketing exclusivity offered to pharmaceutical firms by the law, orphan drugs would probably not be developed, produced and commercialized. Traditional CSR practices (corporate philanthropy, community and neighborhood programs, volunteerism etc.) cannot be treated as sufficient ‘compensation’ for the high prices of medicines. Real, true CSR in the innovative pharmaceutical industry requires either abandoning or reducing extreme monopolistic privileges and offering medicines for rare diseases at lower prices.

scholarly journals INCREASING THE COMPETITIVENESS OF INSURANCE COMPANY PRODUCTS AND SERVICES USING ECONOMIC AND MATHEMATICAL MODELING METHODS

2021 ◽  
Author(s):  
Mykhailo Demydenko ◽  
Ihor Pistunov
Keyword(s):  
Mathematical Model ◽  
Social Activity ◽  
Insurance Companies ◽  
Comprehensive System ◽  
Insurance Company ◽  
Competitive Advantages ◽  
Insurance Policy ◽  
Insurance Policies ◽  
The Impact

The competitiveness of an insurance company depends on the competitiveness of the products and services it introduces in the market. The competitive advantages of the insurance company are expressed in the attractiveness and competitiveness of insurance policies. An economic and mathematical model of increasing the competitiveness of the insurance company is proposed, which allows to calculate the integrated indicator of competitiveness of the insurance policy based on a comprehensive system of indicators characterizing the reliability of the insurance company, quality of its services, competitiveness, social activity. To analyze the impact of these indicators on the competitiveness of the insurance policy and identify areas for improving the efficiency and competitiveness of the insurance company. The competitiveness of an insurance company depends on the competitiveness of the products and services it introduces in the market. The assessment of the quality of insurance company services is compliance with the needs, requirements, and insurance interests of customers. This assessment is performed each time an individual client chooses to cooperate with an insurance company that meets his insurance interests and wishes. Therefore, the overall competitiveness of the enterprise depends on the competitiveness of products and services offered on the market. The competitive advantages of the insurance company are expressed in the attractiveness and competitiveness of insurance policies. The insurance market in recent years has shown consistently high growth, which makes it attractive for doing business. In these conditions, the task of modeling the activities of the insurance company in a highly competitive market environment becomes relevant. A mathematical model of increasing the competitiveness of the insurance company is proposed, which allows to calculate the integrated indicator of competitiveness of the insurance policy based on a comprehensive system of indicators characterizing the reliability of the insurance company, quality of its services, competitiveness, social activity. With the proposed model, insurance companies can objectively assess their weaknesses and strengths to ensure continuous growth and decent competition in a competitive market environment. The model allows you to select performance indicators and perform modeling and determine the consequences of changes in this indicator, analyze the impact of these indicators on the competitiveness of insurance policies and identify areas for improving the efficiency and competitiveness of the insurance company. By conducting such experiments, insurance companies can make more informed choices and decisions, analyze areas of competitiveness, and more efficiently allocate resources.

scholarly journals 6.F. Round table: What is the evidence for and against price transparency in pharmaceutical pricing and procurement?

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
Keyword(s):  
Full Range ◽  
Round Table ◽  
World Health ◽  
Pharmaceutical Pricing ◽  
Price Inflation ◽  
Price Transparency ◽  
Goods And Services ◽  
Pharmaceutical Procurement ◽  
Lower Ability ◽  
Pharmaceutical Prices

Abstract Although the potential for price transparency in pharmaceutical systems has been widely debated, there has been less discussion of the empirical basis to inform policymaking in this area. The lack of price transparency is viewed as one of the biggest barriers to joint pharmaceutical procurement, an initiative that has the potential to drive down pharmaceutical prices by pooling the purchasing power of smaller populations and thus improve the affordability of medicines. However, critics of the call for increased transparency in pharmaceutical pricing argue that such policies would lead to price inflation, particularly for countries with lower ability to pay or limited negotiating power. Given the widespread use of negotiated confidential discounts granted to different payers by manufacturers and the pervasiveness of international reference pricing as a policy mechanism for determining pharmaceutical prices, transparency policies would not only affect countries directly implementing them. As a result, policy-makers are often reluctant and unsure about how to proceed; this became readily apparent in the discussions around the Transparency Resolution at the World Health Assembly in May 2019. A concise overview of the evidence on the consequences of transparency policies is lacking. This panel draws on a wide-ranging literature review that sought to answer the following key research questions: Is there empirical evidence that examines the effect of price transparency on price development (within countries implementing the policy as well as other countries) In the area of pharmaceuticals? Regarding other types of healthcare goods and services? Regarding products from other industries? What insights can we learn from the available evidence and how transferrable is evidence from other healthcare dimensions or other industries to the issue of price transparency for pharmaceuticals? In this workshop we will bring together researchers to discuss the type of evidence available the extent to which it is empirically grounded. The workshop aims to address this issue and highlight evidence gaps for and against price transparency policies. Each panellist will talk for a maximum of 10 minutes presenting insights from their work; audience members will be actively invited to share their insights and reflections. Key messages The debate on price transparency in pharmaceutical systems needs to advance by looking at the full range of evidence available. Highlighting evidence gaps can endorse real world experiments to test theoretical arguments.

scholarly journals Thriving in a changing world – opportunities and challenges for private health insurance companies

2018 ◽  
Vol 1 (2018/1) ◽  
Keyword(s):  
Health Insurance ◽  
Private Health Insurance ◽  
Health Impact ◽  
Insurance Market ◽  
Insurance Companies ◽  
Full Potential ◽  
Global Trends ◽  
Health Insurance Companies ◽  
Health Insurance Market

The health insurance market in Poland reflects global trends – such as the rising awareness of personal health impact on quality of life. As a consequence, the health insurance market has seen substantial growth during the last years, which is forecasted to continue at over 20 percent more than life or P&C insurance globally. However, private health insurance has not yet unlocked its full potential.

scholarly journals The expected impact of applying IFRS (17) insurance contracts on the quality of financial reports

Accounting ◽  
2021 ◽  
pp. 581-590
Author(s):  
Ahmad Dahiyat ◽  
Walid Owais
Keyword(s):  
Financial Reporting ◽  
Cash Flows ◽  
Faithful Representation ◽  
Insurance Companies ◽  
Reporting Standard ◽  
International Financial Reporting Standard ◽  
Financial Reports ◽  
Insurance Contracts ◽  
Analytical Approaches

This study aimed to explore the expected effect of applying the International Financial Reporting Standard (IFRS) 17 Insurance Contracts on the quality of financial reports. The study followed the exploratory descriptive analytical approaches. A questionnaire was developed and distributed to a sample of 120 financial employees in all insurance companies in Jordan. It concluded that the expected impact of applying the standard on the quality of financial reports was significant, especially on the comparability of financial reports, and faithful representation. It was found that there is an expected, statistically significant and positive effect between the application of the standard, and the quality of financial reports in general, and the expected influence of applying the standard and each of comparability, faithful representation, relevance, verifiability, timely, and understandability respectively. The study recommends the application of the standard in the specified time, work to create appropriate conditions, and the need to follow objective assumptions from the company's management for the estimation of cash flows when applying the standard.

scholarly journals A Novel Approach for the Reimbursement of Permanent Partial Dental Disability Following Dental Injury

2015 ◽  
Vol 16 (6) ◽  
pp. 504-506
Author(s):  
Edgar Nehme ◽  
Sami Jad
Keyword(s):  
Quality Of Life ◽  
Insurance Companies ◽  
Court System ◽  
Permanent Disability ◽  
Dental Injury ◽  
System A ◽  
Novel Approach ◽  
New Formula

ABSTRACT Reimbursement of long-term permanent disability following a dental injury can lead to claims and legal involvement by the injured person. This will delay the treatment the patient's quality of life and the court system. A new formula has been hypothesized to address the problem. This might help the stakeholders including patients, insurance companies. The details of calculating the index and its significance are discussed. Implication studies are mandatory to refine the proposed hypothesis. How to cite this article Ayoub F, Nehme E, Jad S, Salameh Z. A Novel Approach for the Reimbursement of Permanent Partial Dental Disability Following Dental Injury. J Contemp Dent Pract 2015;16(6):504-506.

Work of the clinical expert department of the ophthalmosurgical clinic in the context of a pandemic of the novel coronavirus disease

2021 ◽  
pp. 9-14
Author(s):  
O.B. Baleva ◽  
◽  
N.V. Savchenko ◽  
V.V. Egorov ◽  
◽  
...  
Keyword(s):  
Social Distance ◽  
State Institution ◽  
Insurance Companies ◽  
Medical Documentation ◽  
Federal State ◽  
The Novel ◽  
Coronavirus Infection ◽  
Novel Coronavirus ◽  
Clinical Expert

Changes in work of the clinical expert department of the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution (the Khabarovsk branch) in the context of a pandemic of the novel coronavirus disease were analyzed in the article. The difficulties that have appeared in all sections of the work performed are described, both medical and expert: the time for checking the quality of filling out medical documentation has increased due to the identification of a larger number of defects; the time for medical control and discharge of patients from the hospital has increased due to the impossibility of accumulating patients in one place and the need to maintain social distance; difficulties arose in working with experts from insurance companies due to the lack of direct communication (medical records are checked outside the Khabarovsk branch). The concern of people about the possibility of carrying out surgical treatment in conditions of coronavirus infection was expressed in an increase in the information load of the «Question - Answer» section on the website of the Khabarovsk branch and, accordingly, on the doctors in the clinical expert department working with it. Key words: pandemic, COVID-19, SARSCoV-2, anti-epidemic measures, personal protective equipment, social distance, treatment control, medical documentation, medical and economic expertise.

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