Biologics will be about 20% of the world pharmaceutical market in three years, according to a study by the IMS Institute for Healthcare Informatics, part of IMS Health. That amounts to about $220 billion. “Development and production of biologics both branded and generic [biosimilars] is increasingly competitive, with a broad range of players, from small to large pharma companies,” says the study, “The Global Use of Medicines: Outlook Through 2017.”

Biologics’ share of total pharmaceutical sales worldwide

Developed markets (United States, France, Germany, Italy, Spain, United Kingdom, Japan, Canada, and South Korea) will be dominated by brand-name pharmaceuticals in 2017. Meanwhile, generics will dominate emerging markets — China, Brazil, Russia, and India — accounting for 63% of the total share. “While spending on brands in [emerging] markets will continue to grow in absolute terms, their relative share will decline from 31% to 26% by 2017, reflecting more rapid expansion of access to generics compared to the uptake of innovative branded medicines.”

Generics to gain market share

Spending on specialty pharmaceuticals is expected to increase by 30% in developed markets by 2017 and nearly 90% in emerging markets. “Innovative drug launches will be dominated by specialty medicines, reflecting a development pipeline that has an abundance of specialty products at all stages and particularly in the field of oncology.”

Specialty spending through 2017 (in billions)

Source: “The Global Use of Medicines: Outlook Through 2017,” IMS Institute for Healthcare Informatics, November 2013

Nonetheless, specialty drugs will be harder to come by in the emerging markets, “with access, particularly to the latest medications, a continuing issue for patients in these countries.”

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.