Pricing and Reimbursement of the Healthcare System in India- Low Levels of Drug Reimbursement Lead to a High Out-Of-Pocket Expenditure

GBI Research, the leading business intelligence provider, has released its latest research “Pricing and Reimbursement in India- Low Levels of Drug Reimbursement Lead to a High Out-Of-Pocket Expenditure”. It provides a comprehensive overview of the healthcare system, and pricing and reimbursement process in India with a detailed analysis of the different regulatory mechanisms used in India. The report closely scrutinizes the major changes in pharmaceuticals related pricing and reimbursement in the recent past, and the impact these changes will have in the future. The health insurance is responsible for facilitating demand by making high-cost prescription drugs more affordable. Although the per capita income is rising in India, the modest income of most of the population keeps the high cost drugs and medicines out of reach of the majority of the population. Drugs would become more expensive with the enforcement of product patents and so the sales of the expensive drugs depend on the growth and the maturity of the health insurance sector. If the health insurance industry does not mature, the market for patented drugs would experience adverse effects. The next three to five years will see a significant growth and change in the Indian health insurance industry as new insurance players and insurance products respond to the increased demand. India has a dual system of care: a private fee-for-service based sector where the money is paid Out-Of-Pocket (OOP) by individual households and a tax-based public sector where the providers are salaried. The utilization of insurance under both these systems is partly restricted by the affordability of the individual household and availability of the budget. On the other hand, insurance, as a means of financing, is a far more sophisticated mechanism, requiring a comprehensive understanding of the failures that characterize health insurance markets. Despite the improving health status of the Indian population, healthcare infrastructure in India is far from achieving 100% quality, technology and superior healthcare delivery systems. While the Central Government is limited to family welfare and disease control programs, the state governments are responsible for primary and secondary medical care, with a limited role in specialty care. Looking at the healthcare indicators and the growing prevalence of non-communicable lifestyle related diseases, both the government and private sector realize the need to meet this basic demand. Today, the private sector provides 80 percent of the healthcare service.

Scope

• Detailed study of the healthcare systems and roles of the key insurance players in the drug reimbursement process
• Analysis of the major pricing and reimbursement mechanisms in India.
• Key trends that follow from the recent changes brought about in the pricing and reimbursement mechanism.
• Build an understanding of the possible major challenges brought about by the enactment of changes in the pricing and reimbursement scene in India.

Reasons to Buy

• Build understanding of the pharmaceuticals related key pricing and reimbursement mechanisms in India and also specifically in some states of India.
• Optimize your investment through the identification and understanding of the changes in the pharmaceuticals regulatory mechanism in the Indian economy.
• Develop effective business strategies related to new drug launches through the analytical insight gained from key trends in the pricing and reimbursement scene of India.
• Improve negotiations with the government agencies to maximize reimbursement on the drugs by understanding the mechanism.

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Table of Contents

1.1 List of Tables
1.2 List of Figures

2 Pricing and Reimbursement in India- Executive Summary
2.1 High Out-Of-Pocket Expenditure of 78% Limits Healthcare Spending
2.2 Reference Pricing can be Adopted for Generic Products and “Me-Too” Branded Products
2.3 Annual Turnover and the Demand of a Drug are the Main Rationale to Fix the Price of a Drug

3 Pricing and Reimbursement in India- Introduction
3.1 GBI Research Report Guidance

4 Pricing and Reimbursement in India- Overview
4.1 Introduction to Healthcare System in India
4.1.1 Healthcare Expenditure Highly Correlated with GDP
4.1.2 Estimated Public Health Spending as a Percentage of GDP
4.1.3 Health Expenditure per Capita
4.1.4 Out-of-Pocket Health Expenditure as a Percentage of Private Expenditure on Health
4.1.5 Demographics by Age
4.2 Public Healthcare System
4.2.1 Drug Distribution in the Public Sector
4.3 Private Healthcare System
4.4 Rationale for Drug Use in the Healthcare Facilities

5 Pricing and Reimbursement in India- Overview of Pharmaceutical Regulations in India
5.1 PEST Analysis of the Pharmaceutical Industry in India
5.2 Regulatory Bodies in the Indian Pharmaceutical Sector
5.2.1 National Pharmaceutical Pricing Authority (NPPA)
5.2.2 Drug Prices Control Order (DPCO)
5.2.3 The Pharmaceutical Policy, 2002

6 Pricing and Reimbursement in India- Pricing of Drugs
6.1 Introduction
6.1.1 Price Registration Process in India
6.1.2 International Price Comparison
6.1.2.1 Value-Based Pricing
6.1.2.2 Reference Pricing
6.2 Price Setting Procedures
6.2.1 Essential Drugs List (EDL) Pricing
6.2.2 Pricing Methodology for the Essential Drugs
6.2.3 Factors Determining the Pricing of the Drugs
6.2.4 Criteria for Selection of Drugs for Price Control
6.3 Pricing of Formulations
6.4 Annual Price Adjustments
6.5 Distribution of the Price Reduction Under National Pharmaceuticals Pricing Policy 2011
6.6 Branded Generics Share
6.6.1 India-Specific Pricing
6.6.2 Pricing Approach to Patented Drugs
6.6.2.1 Selection of the Comparator Countries
6.6.2.2 Important Considerations while Fixing the Prices of the Patented Drugs
6.6.3 Pricing of the Orphan Drugs
6.6.3.1 Global Approach for Orphan Drug Development
6.6.3.2 Introduction of the Sales Ceiling and Flexible Market Exclusivity
6.6.4 Introduction of the Jan Aushadhi Shops

7 Pricing and Reimbursement in India - Reimbursement Scenario in India
7.1 Introduction
7.2 Health Insurance
7.2.1 Central Government Health Scheme
7.2.2 Employees State Insurance Scheme
7.3 Medical Reimbursement in India
7.3.1 Reimbursement Plans of Major Insurance Players
7.3.1.1 Oriental Insurance Company Limited
7.3.1.2 National Insurance Company Limited
7.3.1.3 New India Assurance Company Limited
7.3.1.4 Birla Sun Life Insurance
7.3.2 Private and Public Sector Insurance Companies in India
7.4 Reimbursement Policies in Other Countries
7.5 Out-of-Pocket (OOP) Expenditures
7.5.1 Co-Payment
7.5.2 Out-of-Pocket Expenditures in India
7.5.3 A Comparison of OOP Expenditures
7.5.4 Irrational Drug Usage
7.6 Universal Health Care
7.7 Trends in Drug Reimbursement Policies
7.7.1 Health insurance Scenario in India
7.7.2 Challenges in Health Insurance

8 Pricing and Reimbursement in India- Conclusion

9 Pricing and Reimbursement in India- Appendix
9.1 Market Definitions
9.2 Abbreviations
9.3 Research Methodology
9.3.1 Coverage
9.3.2 Secondary Research
9.3.3 Primary Research
9.3.3.1 Overview
9.3.3.2 Overview of Pharmaceutical Regulations in India
9.3.3.3 Pricing of Drugs
9.3.3.4 Reimbursement Scenario in India
9.3.4 Expert Panels
9.4 Contact Us
9.5 Disclaimer
9.6 Sources

List Of Tables

Table 1: Pricing and Reimbursement in India, Centre’s Expenditure on Health and Family Welfare, 2004-2010
Table 2: Pricing and Reimbursement in India, Estimated Public Health Spending (%) of the BRIC nations, the US, the UK and Japan, 2010-2050
Table 3: Pricing and Reimbursement in India, Health Expenditure per Capita ($), BRIC, The US, The UK, Japan, 2006-2009
Table 4: Pricing and Reimbursement in India, Out-of-Pocket Health Expenditure as a Percentage of Private Expenditure on Health, (%), BRIC, The US, The UK, Japan, 2006-2009
Table 5: Pricing and Reimbursement in India, Demography by Age, 2011
Table 6: Pricing and Reimbursement in India, Public Healthcare System in India & The US (Rate), 2010
Table 7: Pricing and Reimbursement in India, Rationale for Drug Use in India by WHO, 2010
Table 8: Pricing and Reimbursement in India, Essential Drugs List, 2011
Table 9: Pricing and Reimbursement in India, Categories of Drugs and MAPE, DPCO 1979
Table 10: Pricing and Reimbursement in India, Number of Drugs under DPCO, Year-on-Year 1970-2011
Table 11: Pricing and Reimbursement in India, Distribution of the Price Reduction of Drug, 2011
Table 12: Pricing and Reimbursement in India, Drug Price Comparison, Market Price & Jan Aushadhi Price, 2011
Table 13: Pricing and Reimbursement in India, Non-Profit Social Insurance Schemes in India, 2011
Table 14: Pricing and Reimbursement in India, Health Insurance Policy of the OICL, 2011
Table 15: Pricing and Reimbursement in India, Private and Public Sector Health Insurance Companies, 2011
Table 16: Pricing and Reimbursement in India, Reimbursement Policies in the Top Five Countries of Europe, 2011
Table 17: Pricing and Reimbursement in India, Co-Payments in Other Countries, 2011
Table 18: Pricing and Reimbursement in India, Out-of-Pocket Expenditures in India, 2011
Table 19: Pricing and Reimbursement in India, Comparison of OOP Expenditures, 2011
Table 20: Pricing and Reimbursement in India, Irrational Drug Usage in India, 2010
Table 21: Pricing and Reimbursement in India, Percentage of Untreated Population in India, 2010
Table 22: Pricing and Reimbursement in India, Difference between Co-op and Market Price of Generic Medicines, 2011
Table 23: Pricing and Reimbursement in India, Trends in Indian Healthcare Industry, 2011

List of Figures

Figure 1: Pricing and Reimbursement in India, Healthcare Expenditure in India, 2010
Figure 2: Pricing and Reimbursement in India, Impact of Reference Pricing, 2011
Figure 3: Pricing and Reimbursement in India, Healthcare Expenditure in India, 2010
Figure 4: Pricing and Reimbursement in India, PEST Analysis of the Indian Healthcare Industry
Figure 5: Pricing and Reimbursement in India- Pricing of Bulk Drugs in India, 2011
Figure 6: Pricing and Reimbursement in India, Price Registration Process in India, 2011
Figure 7: Pricing and Reimbursement in India, Value-Based Pricing, 2010
Figure 8: Pricing and Reimbursement in India, Impact Analysis: Reference Pricing, 2010
Figure 9: Pricing and Reimbursement in India, Factors Determining the Pricing of the Drugs, 2011
Figure 10: Pricing and Reimbursement in India, Pricing of Formulations in India, 2011
Figure 11: Pricing and Reimbursement in India, Trends in Drug Prices, 1995-2010
Figure 12: Pricing and Reimbursement in India, Branded Generics Share in India, 2010
Figure 13: Pricing and Reimbursement in India, India-Specific Pricing, 2010
Figure 14: Pricing and Reimbursement in India, Concerns Regarding the Pricing of the Patented Drugs
Figure 15: Pricing and Reimbursement in India, Global Pricing of Orphan Drugs, 2010
Figure 16: Pricing and Reimbursement in India, Challenges in Indian Healthcare System, 2011
Figure 17: Pricing and Reimbursement in India, Health Insurance in India, 2011
Figure 18: Pricing and Reimbursement in India, Specific Disorders Not Covered in the Policy, 2011
Figure 19: Pricing and Reimbursement in India, Out-of-Pocket Expenditures in India, 2011