Innovative biotechnology industry strategies in the U.S.’ rapidly evolving payer environment

Authors

  • Sarah Stanton Collins America'sHealth
  • Will Collins

DOI:

https://doi.org/10.5912/jcb540

Keywords:

payer, cost, market behavior, competitive strategy

Abstract

In 2010 healthcare represented 17.9% of GDP; its cost is growing significantly faster (~5%) than economic growth (~ 2%).  This growth presents a challenge to all payers, whether they are governments, employers, or individuals.  Within healthcare, one of the most rapidly growing areas is “specialty drugs†which are frequently biotechnology agents, or drugs for cancer or orphan conditions.  This article starts by discussing the issues of specialty drug cost and the challenges payers face in managing specialty drugs.  It then presents market structure and firm strategy theories that provide insight into firm behavior in specialty drug categories.  Lastly, it discusses possible events and actions that could dramatically change the biotechnology industry and lead to increased value within the U.S. health care system.

Author Biography

  • Sarah Stanton Collins, America'sHealth
    President

References

Louise Radofsky. Wall Street Journal, Tuesday January 2012. page A2

HTTP:///www.prnewswire.com/news-releases/us-healthcare-costs-annual-growth-rates-increase-in-october-2011-according-to-the-sp-healthcare-economic-indices-135655078.html

The Economist, December 17th, page 14 (all three statistics)

The definition of specialty drugs that Express Scripts used in developing its data (and used in a chart documenting growth in specialty spending in a chart below) data is injectable, infused, oral or inhaled drugs that have one or more of the following key characteristics: requirement for frequent dosing adjustments and intensive clinical monitoring to decrease the potential for drug toxicity and increase the probability of beneficial treatment outcomes; the need for intensive patient training and compliance assistance to facilitate therapeutic goals; limited or exclusive product availability and distribution; specialized product handling and/or administration requirements; cost in excess of $500 for a 30 day supply.

The EMD Serono Specialty Digest, 7th Edition reports that “80% of payers typically classify a drug as specialty if the average monthly cost exceeds $1,200 and may include other factors, such as whether the product treats a rare disease, requires special handling, has a limited distribution network, or requires ongoing clinical assessment and monitoring or response and/or side effects.†Page 10. accessed from http://www.specialtydigest.emdserono.com on January 9, 2012

Express Scripts 2010 Drug Trend Report. Accessed from http://www.express-scripts.com/research/researc/dtr on January 8, 2012

Medco 2011 Drug Trend Report accessed from http://drugtrendreport.com on January 8, 2012

ESI reports prevalence of RA as 0.22%, and MS at 0.11% prevalence within its covered population.

Express Scripts 2010 Drug Trend Report. Page 68. Accessed from http://www.express-scripts.com/research/researc/dtr on January 8, 2012

SSC identify page and what two drugs were

Interview with Dr. Owens January 5th 2012.

Medco 2011 Drug Trend Report. Page 37. accessed from http://drugtrendreport.com on January 8, 2012

Ibid, page 46, 47

www.census.gov/popclock.html

EMD Serono. EMD Serono Specialty Digest, 7th edition Managed Care Strategies for Specialty Pharmaceuticals. Page 10.

ibid

Express Scripts 2010 Drug Trend Report. Accessed from http://www.express-scripts.com/research/researc/dtr on January 8, 2012

Dr. Michael E. Porter. Competitive Strategy Techniques for Analyzing Industries and Competitors. The Free Press. 1998, pages 7-13.

Shenkar, Oded. Copycats how smart companies use imitation to gain a strategic advantage. Harvard Business Press. 2010

Dr. F.M. Scherer, Dr. David Ross,. Industrial Market Structure and Economic Performance, Third Edition. Houghton Mifflin Company. 1990.

Ibid, page 32

Ibid page 226

Ibid, pages 248-249

Ibid, page 352

John Carroll. Everyone Wants in, but with no Ground Rules, the Biosimilar Business Remains Elusive/ Biotechnology Healthcare. Fall 2011. Page 12.

Express Scripts 2010 Drug Trend Report. Page 5. Accessed from http://www.express-scripts.com/research/researc/dtr on January 8, 2012

Joanna Brougher, The Biosimilars Act: Promoting or Discouraging the Development of Generic Biologics? Biotechnology Healthcare. Winter 2010. Page 22.

IOM etc.

The Economist, December 17th, page 14 (all three statistics)

http://www.ssa.gov/oact/COLA/AWI.html

Biotechnology Healthcare, Spring 2011. Page 22. Interview by Sarah Collins.

http://liheap.ncat.org/profiles/povertytables/FY2011/popne.html

Michael Dalzell. How will Biologics Fit Into Healthcare Reform? Biotechnology Healthcare. Winter 2011. pages 6 – 10.

Interview with Debra Stern, Vice President of Rxperts, January 5, 2012. Comments also by Kip Piper, former State Health Commissioner for Wisconsin, and Jerry Wells, former Florida Medicaid program Pharmacy Director. All three are long-term consultants in the managed care industry.

By “players:†we mean individual companies or teams of companies. The first could be likened to a chess player, the latter to a basketball team.

Henry G. Grabowski, David B. Ridley, Kevin A. Schulman. Entry and Competition in Generic Biologics. Managerial and Decisions Economics 28 (2007): 439-51.

Annabel Keuk, Brian A. Hazelman. Immune-mediated Inflammatory Diseases and Biologic Therapy: A Medical Revolution. Postgrad Medical Journal 83 (2007) 251-60

Ian A. Sutherland. A Review of Liquid-liquid Chromatography Using Aqueous Two Phase Solvent System. Current Opinion in Drug Discovery and Development 10 (2007) 540-49.

John Carroll. Everyone Wants In, but with No Ground Rules, the Biosimilars Business Remains Elusive. John Carroll. Biotechnology Healthcare. Fall 2011, page 13. accessed from http://www.biotechnologyhealthcare.com/

Interview conducted July 11, 2011

High deductible or consumer driven health plans have high annual deductibles such as z$1,000 - $5,000 per beneficiary, that must be met before plan cost-sharing begins.

Express Scripts 2010 Drug Trend Report, Pages 65 & 67. Accessed from http://www.express-scripts.com/research/researc/dtr on January 8, 2012

Ibid, page 67

http://www.consumerreports.org/health/best-buy-drugs/drug-report-archives.htm

The American Customer Satisfaction Index, specialty retail industry

http://thinkexist/quotation/a_crisis_is_an_opportunity_riding_the_dangerous/182149

Published

2012-07-01

Issue

Section

Article