瑞银全球医疗保健行业美国药品价格改革对制药生物技术和其他医疗行业意味着什么2019618115页

GlobalResearch18June2019Q-SeriesWhatwillUSdrugpricingreformmeanforpharma,biotech,andotherhealthsectors?Drugpricing:AcaseofAmericanexceptionalismDrugpricingintheUnitedStatesisastrikinganomaly:4%oftheworld'spopulationconsumed64%ofthevalueofnewdrugslaunchedbetween2012and2017.TheanomalyisamajorbenefittodrugcompanyshareholdersandtocountrieswhosedrugpricingdoeslittletoincentiviseR&D.SowhyistheUSanexception?Probablybecauseofauniquepoliticalphilosophythathaskeptthegovernmentoutofpricesetting.Butpoliticalphilosophywearsthinwhenenoughvotersstrugglewithout-of-pocket(OOP)costs,andenoughpoliticiansworrythatthefederalgovernment,theworld'slargestdrugbuyer,oftenpays~2xasmuchasotherdevelopedcountriesforthesamebasketofdrugs.Withthatbackdropandauniquecurrentpoliticalenvironment,webelievemeaningfulreformismorelikelynowthaninrecenthistory.ExplainingandevaluatingtheUSreformoptionsInthisQ-Series,weexplainandevaluatetheplethoraofreformoptionscurrentlyunderdebateandtheprocessbywhichtheymightbeturnedintoareformpackage.WeconsidertheimplicationsforourUSandEuropeandrugandbiotechcoverage,andforadjacentsectors(e.g.,PBMs,UShealthinsurers,pharmaceuticalsupplychainlifesciencecompanies,Chinesepharma,etc.).Wefocusonreformsthatarelikelytocrystalizein2019,butalsoexplainmoreradicalproposalsfromtheDemocratswhoseimplementationispossible,ifunlikely,afterthe2020elections.Reformislikely:Whatwethinka2019reformpackagemightlooklikeOurbasecaseisthattherewillbemeaningfulreform.InMedicarePartD($165bnofdrugstakenathomebytheelderly),OOPcostswillbecappedandmandatorydiscountsonPartDdrugswillshiftfrommid-priceddrugsintheso-calleddonutholetotheexpensivespecialtydrugsthathavebeendrivingmuchofPartDcostgrowth(acategorytotalling$50bnofspendwithonly15%,or$7.5bn,currentlycoveredbyinsurers/manufacturers).ThenewdiscountswillalsofundtheconsumptionincreasefromthedeclineinOOPcosts.InMedicarePartB(drugsgiventotheelderlyinout-patientclinics),weexpectmechanismstoincentivisecompetitiveprocurementofbiosimilarsandperhapsotherdrugsincrowdedtherapyareas.Wealsoexpectreformstomakeiteasiertomakegenericandbiosimilarchallenges.OurworstcaseforhealthcarestocksassumesalargepilotprojecttobenchmarkMedicarePartBdrugsagainstotherdevelopedcountries.Ourbestcaseforhealthcarestocksassumespoliticalgridlockandminimalreform.Howisthemarketpositionedforthechangesthatarelikely?Weprovideaframeworkforevaluatinghowdifferentcompanieswillbehitbyreform.Wedon'tthinkthemarketispricing-inashiftinPartDdiscountsfrommid-pricedtoexpensivedrugs.Ifthishappens,itwillshiftvaluetowardsstockslikeSanofi,NovoNordisk,andEliLillyandawayfromstockslikeIncyteandCelgene/Bristol.WethinkthemerethreatofinternationalreferencepricingmayuncoupletheUSdrugmarketfromlow-priceddrugmarketsoutsidetheUS.ThiswouldbegoodforinnovativedrugcompaniesbasedinChina.Itwouldalsoconstraintheex-USgrowthofWesterndrugcompanieswhoseektofocusonsellinghighpriceddrugsintheUS.WealsothinkitisunlikelythatPBMbusinessmodelsaremateriallyimpactedbyreform,andthesecompaniesmaybenefitmostastheymaymanageagreaterpoolofdrug[e-mail][e-mail][e-mail][e-mail][e-mail][e-mail][e-mail][e-mail][phone]RachelYang,[e-mail][phone]MatthewTaylor,[e-mail][phone]DanBrennan,[e-mail][e-mail][phone]Q-Series18June20192ContentsExecutivesummary..........................................................................4Mainconclusion:Reformislikely.................................................................4Whatreformisthemarketpricing-in?.........................................................6Potentialreformoutcomesandstockimpacts..............................................9Introduction....................................................................................20Scopeandaimsofthisreport....................................................................20Thesizeofthings:WhyUSreformmatters................................................20Politicalcontextrevisited............................................................................25Mainreformproposalsinsummary.............................................28WhiteHouseproposals..........