Gallwitz: If there is a change from the Republican to a Democratic administration in 2008, what will that do to the viability of Medicare
going forward? How much change can we expect? Playing out those types of scenarios and getting ahead of the possibilities
associated with a product-level perspective as well as franchise level will be very, very critical for companies.
Breitstein: There's a lot industry doesn't know about the impact of Part D. What are some things companies can predict?
Bajpai: We'll see more generic usage because of all the out-of-pocket costs and increased use of step therapy. It will be interesting
to compare your drug versus the class, where the total class will shrink for the first time.
Mandated step therapy and preferred drug usage, those types of barriers, could make your market share go crazy. So we need
to track many things—and that's just the tracking piece, not even looking more in-depth to decide how decisions will be made
going forward: How confused are the physicians? How confused are the patients? Patients approaching pharmacists—a group pharma
has abandoned for advice. Employers getting into the mix. It is very complicated. It will be interesting to see whether people
engage in navigating the system.
Clinton: What have you found so far?
Lurker: It's not pretty. On the patient side, most seniors are confused.
Saatsoglou: Particularly because pharma companies cannot support patient programs for enrolled seniors. Once people make the move into
Medicare, then they can't participate in a company's indigent program.
Brodsky: There are opportunities for Pfizer and other companies to provide information and expertise to CMS to help them develop messages
and communicate with seniors. We all have a stake in trying to make this a success in terms of benefit to the potential enrollees.
Breitstein: How will companies react?
Kalb: Pricing freedom in the United States is possibly the single most important issue that faces the industry over the next 10
years. Although only 40 to 50 percent of sales come from the United States, around 60 to 70 percent of profits come from the
If the government obtains a role in negotiating price, Medicare can trigger other public and private programs, and we commoditize
the industry in the United States. Then there is a need to find other places to generate profit for the business, which may
be Asia or other emerging markets.
Brodsky: The notion of the risk/benefit trade-off of drugs is going to drive pricing latitude. All the pieces of that system really
need to be understood, again, more like packaged goods products where there is fuller information around how the alternatives
are priced relative to what the benefits are. The more we can foster discussions about the benefits, total costs, and risks
of the alternatives relative to one another, that's going to drive pricing latitude and ultimately affect the negotiations.
Gallwitz: From a researcher's perspective, does the MMA change the strategy associated with the R&D investment? If we have products
that will be targeted to an elderly population, I now have to take into consideration a different set of rules, where the
government is the largest payer.
Fox: Certain measures are going to become more important, like tracking switching of products to generic or to a lower-cost brand
or a different formulary brand. Using patient longitudinal data combined with attitudinal data to understand—from the seniors'
perspective—what they're going to do about Medicare. Linking that with their actual behavioral data. We'll need to use all
tools available to us, like monitoring supply and overall persistency measurements, to predict if patients that don't switch
to a generic cut their pills in half to make them last twice as long.