SOURCE: Cutting Edge Information

Cutting Edge Information

November 21, 2016 08:17 ET

Drug Pricing and Reimbursement at Stake Following U.S. Election

RESEARCH TRIANGLE PARK, NC--(Marketwired - November 21, 2016) - The fate of pharmaceutical pricing is one of the biggest questions facing the industry following the general election. Currently, U.S. government payers, such as Medicare, are not allowed to negotiate prices with pharmaceutical companies. But that policy could change under a new administration.

Prior to the election, some drug company executives predicted that the pharmaceutical industry is moving toward publishing the average manufacturer price (AMP) of its products, according to research from Cutting Edge Information.

In a study of the industry's interactions with U.S. government payers, Cutting Edge Information found that the vast majority of companies allocate specific teams to handle contracts and pricing. Most companies (89%) have market access personnel sitting in their contracts and pricing committees. Furthermore, 44% of surveyed companies each have brand teams and marketing personnel involved in their contracts and pricing committees.

Additional data in Cutting Edge Information's study, US Government Drug Reimbursement: Winning Key Formulary Positions and Managing Pricing Systems, show that pharmaceutical companies ranked Medicare Part D and Part B as the two most strategically important payers to drug reimbursement in the United States. That importance is due to the perception that without Medicare and Medicaid reimbursement, commercial payers are far less likely to provide reimbursement.

"With the potential for changes to or the elimination of the Affordable Care Act, drug pricing practices could shift within the pharma industry," said Jacob Presson, Senior Consultant, Data Products at Cutting Edge Information. "Different consumer markets typically receive varying price discounts, so government reimbursement teams may rely on these committees to determine rebates."

US Government Drug Reimbursement: Winning Key Formulary Positions and Managing Pricing Systems, available at, provides a roadmap for navigating government drug reimbursement. The report, derived from primary research, surveys and direct interviews, focuses exclusively on U.S. government reimbursement strategies and trends, draws on quantitative and qualitative data from top-performing life science companies to provide actionable insights for winning and maintaining formulary position. Additional guidance outlined in the report includes:

  • Anticipating government payer needs and developing strong market access strategies
  • Managing payer relationships before and after product launches to maintain formulary position
  • Understanding compliant government reimbursement practices in the United States' new healthcare environment

To learn more about Cutting Edge Information and its market access research report offerings, please visit

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