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

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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.

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ibid

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Ibid page 226

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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.

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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.

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Published

2012-07-01

Issue

Section

Article