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Blog: Affordable Care Act

What does the future hold for the US pharma industry?
Everywhere you go in the States, you hear talk of the Affordable Care Act, also known as ObamaCare.  In essence, the ACA is designed to broaden coverage to the millions of Americans who have not had healthcare in the past due to not being employed or just not being able to afford it.  ACA had a rocky time getting passed into law and now that it has launched on January 1, 2014, things are not getting much  easier.  After the President promised that no one who likes his/her doctor would have to switch doctors,  some folks are being dropped by their insurance and do have to leave their doctors.  Younger people almost certainly have to pay more than they have been paying for coverage because the way the new system is structured,  younger, healthier people are underwriting the costs for older people who utilize the healthcare system more frequently (and at greater cost). At the core of the debate is a values questions:  some people truly believe that everyone should have access to the healthcare system as provided by the ACA. Others exude a really American spirit of not wanting any government intervention or interference in their lives. So despite the fact that this program might be advantageous to many, it represents an intrusion. This disagreement is unlikely to be easily resolved as it is a core values question. 

It has been almost a given that full time employees offer some level of healthcare coverage to employees and some employers are taking advantage of this shift in the landscape to divorce employment from healthcare benefits and force  their employees to shop independently for coverage on the newly created exchanges.  In fact,  this has happened to my own husband.  So this represents added expense to the employees, unless the employers decide to underwrite the cost in some way (which has yet to be determined).  This is “a great unknown” and something that will be determined company to company, not on a national level.

There are some facts that are emerging, although the system is still unfolding.  Some folks will have to change physicians and physicians will have to see more patients, possibly at a lower reimbursement rate than before.  The rates themselves are still unclear and may not be clear for quite some time.  The system is structured so that everyone will have access to care; in fact, everyone must have access to care. That means that there are financial penalties if people don’t sign up. 

So everyone is a bit at sea.  Pharma companies, too are wondering about the impact of the ACA on their worlds.  What guidelines will physicians have to follow in prescribing?  What tests will be covered?   What types of reporting will they have do (electronic record keeping)?  I spoke to my colleague from our sister company,  Access Partnership about this.  His idea is that   things are unclear in part because, although the Supreme Court upheld the centerpiece of the Affordable Care Act more than a year ago, there are still several legal challenges to the new system, which may slow down the implementation and make it difficult to envision how the new system will play out over time. 

As of right now, the Affordable Care Act is just beginning and it is difficult to see “around the next bend” as to what the long term implications will be for the interested parties (and by that I mean everyone!).

Research Partnership is one of the largest independent healthcare market research and consulting agencies in the world. Trusted partner to the global pharmaceutical industry, we use our expertise and experience to deliver intelligent, tailor-made solutions. We provide strategic recommendations that go beyond research, helping our clients to answer their fundamental business challenges. Find out more here:

1st April 2015



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