1 Table of Contents

1.1 List of Tables
1.2 List of Figures

2 Pricing and Reimbursement in the US - Introduction

2.1 GBI Research Report Guidance

3 Healthcare System in the US - Overview

3.1 Healthcare Expenditure
3.1.1 Healthcare Expenditure and GDP
3.1.2 Healthcare Expenditure by Category

3.2 Healthcare Infrastructure
3.2.1 Hospitals
3.2.2 Hospital Beds
3.2.3 Healthcare Professionals

3.3 Health Insurance
3.3.1 Health Insurance Coverage
3.3.2 Health Insurance Providers

3.4 Demographic Trends Affecting Healthcare
3.4.1 Population Demography

4 Pharmaceutical Regulations in the US - Overview

4.1 Pharmaceutical Industry in the US
4.1.1 PEST Analysis

4.2 Healthcare Regulation
4.2.1 Highlights of the Budget 2011-2012

5 Pricing of Pharmaceutical Drugs in the US

5.1 Pricing Overview
5.1.1 Regulatory Bodies
5.1.2 Pricing Control
5.1.3 340B Drug Pricing Program

5.2 Key Trends
5.2.1 Brand Name Drug Prices Increase in the Face of Generic Competition
5.2.2 Significant Decrease in Average Price of Generic Drugs
5.2.3 PPACA Introduced by the US President to Tackle Soaring Prescription Drug Prices
5.2.4 Generic Price War at Retail Sector

5.3 Major Challenges
5.3.1 Reducing Wastage in Healthcare Spending
5.3.2 Government's Cost Rationalization Efforts will make Future Tough for Big Pharmaceutical Companies
5.3.3 Medicaid Pricing for Dual Eligibles of Medicare Part - D
5.3.4 New ICD-10 (International Classification of Diseases) Coding System
5.3.5 Medicare Part B Drug Pricing Does Not Reflect Market Price Accurately

6 Reimbursement of Pharmaceutical Drugs in the US

6.1 Regulatory Bodies
6.2 Prescription Drugs
6.3 Biologics
6.4 Preferred Drug List (PDL)

6.5 Reimbursement by Health Insurance Companies
6.5.1 UnitedHealth Group
6.5.2 WellPoint, Inc.
6.5.3 Kaiser Foundation Group
6.5.4 Humana Group
6.5.5 Aetna Group

6.6 Pharmacy Benefit Managers (PBMs)

6.7 Reimbursement Programs in the US
6.7.1 Case Studies

6.8 Key Trends
6.8.1 Rebate Reforms and Healthcare Cuts to Reduce Federal Deficit
6.8.2 Medicare Part D Changes in Standard Benefit Parameters
6.8.3 Reimbursement of Brand Name Drugs
6.8.4 Reimbursement of Generic Drugs
6.8.5 CMS Finalizes Medicare Hospital Outpatient Payment Rates for 2012

6.9 Major Challenges
6.9.1 New Nationwide Database to Set Healthcare Reimbursement Rates
6.9.2 First DataBank/Medi-Span Settlement and the Impact on AWP
6.9.3 Renewal of Medicaid Drug Payment Policy
6.9.4 Proposed Cuts in Medicare Part B Reimbursement
6.9.5 New Trend in Free Trade Agreements Could Affect Healthcare Programs

7 Pricing and Reimbursement in the US - Major Therapy Areas

7.1 Pricing and Reimbursement in Major Therapy Areas
7.1.1 Heart Diseases
7.1.2 Cancer
7.1.3 Respiratory Diseases
7.1.4 Cerebrovascular Diseases
7.1.5 Other Major Therapy Areas

7.2 Case Studies
7.2.1 Provenge under Medicare Coverage
7.2.2 AstraZeneca Ensures Reimbursement of Brilinta
7.2.3 Financial Assistance for Orphan Drug Letairis
7.2.4 Coverage for Biologic Product Enbrel

8 Pricing and Reimbursement in the US - Appendix

8.1 Market Definitions
8.2 Abbreviations

8.3 Research Methodology
8.3.1 Healthcare System
8.3.2 Pharmaceutical Regulations
8.3.3 Pricing of Pharmaceutical Drugs
8.3.4 Reimbursement of Pharmaceutical Drugs
8.3.5 Pricing and Reimbursement in Major Therapy Areas

8.4 Contact Us
8.5 Disclaimer
8.6 Sources

List of Tables

Table 1: Pricing and Reimbursement in the US, Healthcare Expenditure as % of GDP versus Life Expectancy at Birth in Years, 1995-2009
Table 2: Pricing and Reimbursement in the US, Comparison of Per Capita GDP and Per Capita Total Expenditure on Health ($ PPP), 2000-2009
Table 3: Pricing and Reimbursement in the US, Per Capita Total Expenditure on Health ($ PPP), The US versus Top Five Countries of Europe, 2009
Table 4: Pricing and Reimbursement in the US, Total Expenditure on Health as % of GDP, The US versus Top Five Countries of Europe, 2009
Table 5: Pricing and Reimbursement in the US, National Healthcare Expenditure ($bn), By Category, 2009
Table 6: Pricing and Reimbursement in the US, Per Capita National Healthcare Expenditure ($ PPP), By Type, 2009
Table 7: Pricing and Reimbursement in the US, Out-of-Pocket Expenditure on Health (% of Total Healthcare Expenditure), The US versus Top Five Countries of Europe, 2009
Table 8: Pricing and Reimbursement in the US, National Healthcare Expenditure (%), Type of Sponsor, 2009
Table 9: Pricing and Reimbursement in the US, Type and Number of Hospitals, 2011
Table 10: Pricing and Reimbursement in the US, Healthcare Professionals, 2010
Table 11: Pricing and Reimbursement in the US, Health Insurance Coverage, Population (in million), 2009
Table 12: Pricing and Reimbursement in the US, Public and Private Health Insurance Coverage (% of Population), 2007-2009
Table 13: Pricing and Reimbursement in the US, Population Demography (Million), 2000-2010
Table 14: Pricing and Reimbursement in the US, Health Indicators, 2000-2010
Table 15: Pricing and Reimbursement in the US, Annual Retail Price Index Change in Brand Name Drugs and Generic Drugs (%), 2008-2010
Table 16: Pricing and Reimbursement in the US, Annual Price Index Change in Prescription Drugs (%), 2008-2010
Table 17: Pricing and Reimbursement in the US, Average Retail Coinsurance Rates (%), By Tier, 2009
Table 18: Pricing and Reimbursement in the US, Top Health Insurance Companies, Revenue ($bn), 2010
Table 19: Pricing and Reimbursement in the US, Reimbursement Programs, 2011
Table 20: Pricing and Reimbursement in the US, State Discount Programs, 2011
Table 21: Pricing and Reimbursement in the US, Medicare Part D Changes in Standard Benefit Parameters ($), 2008-2012
Table 22: Pricing and Reimbursement in the US, Brand Name Drug Cost-Sharing (%), 2011-2020
Table 23: Pricing and Reimbursement in the US, Generic Drug Cost-Sharing (%), 2011-2020
Table 24: Pricing and Reimbursement in the US, Major Therapy Areas by Mortality (%), 2009

List of Figures

Figure 1: Pricing and Reimbursement in the US, Healthcare Expenditure as % of GDP versus Life Expectancy at Birth in Years, 1995-2009
Figure 2: Pricing and Reimbursement in the US, Comparison of Per Capita GDP and Per Capita Total Expenditure on Health ($ PPP), 2000-2009
Figure 3: Pricing and Reimbursement in the US, Per Capita Total Expenditure on Health ($ PPP), The US versus Top Five Countries of Europe, 2009
Figure 4: Pricing and Reimbursement in the US, Total Expenditure on Health as % of GDP, The US versus Top Five Countries of Europe, 2009
Figure 5: Pricing and Reimbursement in the US, National Healthcare Expenditure (%), By Category, 2009
Figure 6: Pricing and Reimbursement in the US, National Healthcare Expenditure (% of Total Health Expenditure), By Type, 2009
Figure 7: Pricing and Reimbursement in the US, National Healthcare Expenditure (%), By Payer, 2009
Figure 8: Pricing and Reimbursement in the US, Out-of-Pocket Expenditure on Health (% of Total Healthcare Expenditure), The US versus Top Five Countries of Europe, 2009
Figure 9: Pricing and Reimbursement in the US, National Healthcare Expenditure (%), Type of Sponsor, 2009
Figure 10: Pricing and Reimbursement in the US, Total Hospital Beds per 1,000 patients, 2000-2009
Figure 11: Pricing and Reimbursement in the US, Health Insurance Coverage (% of Population), 2009
Figure 12: Pricing and Reimbursement in the US, Public Health Insurance Coverage (% of Population), 2009
Figure 13: Pricing and Reimbursement in the US, Private Health Insurance Coverage (% of Population), 2009
Figure 14: Pricing and Reimbursement in the US, Other Private and Government Insurance, 2011
Figure 15: Pricing and Reimbursement in the US, Public and Private Health Insurance Coverage (% of Population), 2007-2009
Figure 16: Pricing and Reimbursement in the US, Population by Age (Million), 2000-2010
Figure 17: Pricing and Reimbursement in the US, Pharmaceutical Industry, PEST Analysis, 2011
Figure 18: Pricing and Reimbursement in the US, Healthcare Regulation, Operating Divisions and their Functions, 2009
Figure 19: Pricing and Reimbursement in the US, Distribution Channel Logistics and Pricing, 2011
Figure 20: Pricing and Reimbursement in the US, Annual Retail Price Index Change in Brand Name Drugs and Generic Drugs (%), 2008-2010
Figure 21: Pricing and Reimbursement in the US, Annual Price Index Change in Prescription Drugs (%), 2008-2010
Figure 22: Pricing and Reimbursement in the US, ICD-10 Coding System; Features and Benefits
Figure 23: Pricing and Reimbursement in the US, Comparison Between Fee for Service, HMO and PPO, 2011
Figure 24: Pricing and Reimbursement in the US, Top Health Insurance Companies, Revenue ($bn), 2010
Figure 25: Pricing and Reimbursement in the US, Standard Medicare Part D Benefit, 2011-2020
Figure 26: Pricing and Reimbursement in the US, Brand Name Drug Cost-Sharing (%), 2011-2020
Figure 27: Pricing and Reimbursement in the US, Generic Drug Cost-Sharing (%), 2011-2020
Figure 28: Pricing and Reimbursement in the US, Major Therapy Areas by Mortality (%), 2009