Over the past few years, pharmaceutical sales in the emerging markets have regularly been growing at double-digit rates, albeit in some of the markets there has been a temporary blip caused by the global credit crunch. Much of the recent growth has been fuelled by an expansion in public sector health insurance coverage, which means that drug reimbursement is much more widespread than in the past. However, the growth of reimbursement systems, combined with the ongoing global economic difficulties, has put pressure on governments to introduce more rigorous price-control mechanisms than in the past.
This report provides a concise examination of the pricing and reimbursement environment in seven of the most important emerging markets. In doing so, it highlights differences in the pricing methodology used in the public and private sectors, and it also focuses on differences in the pricing structure for originator drugs and generics.
The report does not limit itself merely to what is happening currently, but also explores how government policy in each of the individual emerging markets is likely to shape the P&R environment in the future. The seven key emerging markets covered in this report are Brazil, China, India, Mexico, Russia, South Korea, Turkey
Key features of this report
• The report tracks the development of the health insurance system (both public and private) in each of the seven emerging markets, and explores issues such as sources of funding and population coverage.
• The report provides a detailed analysis of the reimbursement environment in each of the seven emerging markets, paying particular attention to how it relates to the market’s health insurance system.
• The report provides a detailed analysis of the pricing structure in each of the seven emerging markets, differentiating between the structure that is in place for originator drugs and generics. Where applicable, it also examines how the pricing mechanism differs for the private and public sectors.
• The report provides a unique insight into the role that is played by the distribution chain from a P&R perspective, examining both formal and informal distribution margins.
• The report examines government policy in relation to pricing & reimbursement, and looks ahead to what changes in the P&R environment are likely to take place in the future.
Key benefits from reading this report
• Allows marketers to operate with confidence in the often complex pricing and reimbursement (P&R) environment in seven key emerging markets.
• Allows marketers to prepare fully for the impact that the arrival of generic competition would cause from a P&R perspective.
• Provides marketers with vital intelligence about the sometimes murky criteria that are used for the inclusion of drugs on government reimbursement lists.
• Forewarns marketers about rebates on official prices that are sometimes mandatory in the public sector.
• Provides marketers with an insight into distribution practices, including kickbacks and informal margins.
• Allows marketers to plan ahead with confidence by looking ahead to the P&R policies that are likely to help shape these seven markets in the future.
Key findings of this report
Each of the seven emerging markets under review has its own unique P&R environment. Even in those emerging markets where reference-pricing is used, there is a wide variation in the countries that are being referenced.
Despite the expansion of public sector health insurance coverage, a high proportion of expenditure is still derived from out-of-pocket payments by consumers.
The recent global economic upheaval has placed additional stresses on the P&R environment of the emerging markets, and it has encouraged the imposition of new price control mechanisms.
However, despite this economic upheaval, governments in the emerging markets are pressing ahead with previous plans to expand public sector health insurance coverage (and by extension to increase the accessibility of drugs).
The proportion of people using private sector health insurance coverage remains very limited in most of the emerging markets. However, in several markets, the uptake of private sector health insurance is growing rapidly from a small base, mainly in urban areas.
The authorities in several emerging markets have been seeking ways to encourage a greater uptake of generics instead of expensive branded drugs. Nevertheless, in countries such as China there is scope for a higher number of innovative drugs to be reimbursed.
Future growth prospects for all seven of the emerging markets remain strong.
Key questions answered by this report
• What is the precise pricing methodology used by each of the emerging markets?
• What role is played by the distribution chain in the pricing of drugs?
• Are there differences in the pricing structure for local drugs and imported drugs?
• In what way does the arrival of generic competition impact on the pricing of originator drugs?
• Are there any special pricing requirements for drugs used by the public sector?
• Are there any variations in pricing on a regional level?
• How quickly is public health insurance coverage expanding?
• Are reimbursement lists beginning to include a larger number of innovator drugs?
• Are governments maintaining previous commitments to increase healthcare spending?
• In what direction is government policy taking the markets from a P&R perspective?
Pricing and Reimbursement in Emerging Markets
Executive summary 8
Introduction 8
Brazil 9
China 10
India 11
Mexico 12
Russia 13
South Korea 14
Turkey 15
Chapter 1 Introduction 18
Summary 18
Recent historical perspective 19
Growth drivers 20
Access barriers 21
Key pricing and reimbursement factors 24
Reimbursement lists 24
Pricing methodology 25
Role played by distribution chain 26
Future outlook 27
Chapter 2 Brazil 30
Summary 30
Introduction 31
Public sector provision 32
Private sector provision 33
Reimbursement system 34
Pricing mechanism 35
Price revisions 36
Public sector discounts 36
Pricing in practice 37
Future outlook 38
Chapter 3 China 42
Summary 42
Introduction 43
Public sector provision 43
Urban areas 44
Rural areas 44
Private sector provision 45
Reimbursement system 45
Essential Drugs List (EDL) 46
Reimbursement levels 47
Pricing mechanism 47
EDL pricing 48
Hospital margins 49
Future outlook 49
Chapter 4 India 52
Summary 52
Introduction 53
Public sector provision 53
Private sector provision 54
Reimbursement system 55
Pricing mechanism 56
Price revisions 58
Distribution margins 59
Future outlook 59
Chapter 5 Mexico 62
Summary 62
Introduction 63
Public sector provision 63
Private sector provision 65
Reimbursement system 66
Pricing mechanism 66
Public sector 66
Private sector 67
Future outlook 69
Growth factors 69
Further price pressure expected 69
Chapter 6 Russia 72
Summary 72
Introduction 73
Public sector provision 74
Private sector provision 74
Reimbursement system 75
Pricing mechanism 76
DLO drugs 76
Non-DLO drugs 77
Impact of price controls 78
Future outlook 79
Chapter 7 South Korea 82
Summary 82
Introduction 83
Public sector provision 83
Private sector provision 85
Reimbursement system 86
Pricing mechanism 87
Pricing dynamics 87
Future outlook 89
Chapter 8 Turkey 92
Summary 92
Introduction 93
Public sector provision 94
Private sector provision 95
Reimbursement system 95
Prescribing practices 96
Pricing mechanism 97
Future outlook 98
Appendix 100
Methodology 100
Glossary 100
List of Figures
Figure 2.1: Brazil: pharmaceutical sales, 2005-2009 31
Figure 2.2: Brazil: private health insurance turnover, 2003–2009 34
Figure 4.3: India: price structure for price-controlled formulations 58
Figure 5.4: Mexico: number of affiliates of healthcare schemes, 2009 64
Figure 7.5: South Korea: organizational structure of NHI system 84
Figure 8.6: Turkey: breakdown of generic/originator products available on market 94
List of Tables
Table 1.1: Emerging markets: per capita spend on pharmaceuticals, 2008 20
Table 1.2: Emerging markets in global context: health expenditure ratios, 2000–2007 23
Table 2.3: Brazil: average drug price by medicine type, 2007–2008 38
Table 4.4: India: list of scheduled bulk drugs (DPCO 1995) 57
Table 5.5: Mexico: provisional health budget by sector, 2010 65
Table 8.6: Turkey: distribution margins for drugs 97
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