Implications of the newly insured
The specifics around the scope of Medicaid expansion and designs of insurance exchanges are currently being ironed out. However,
there are already a few key implications for pharmaceutical companies and medical device companies to consider:
» The expanded insured US population broadly benefits the industry through greater sales potential, particularly in indications
where patients may have previously been uninsured or underinsured.
» MCOs, already the key customer for many products, will become an even more important partner for manufacturers to build
» Management trends seen in commercial plans (e.g., capitated payments) are likely to be used more broadly in Medicaid as
greater management responsibilities fall to MCOs.
» Insurance exchange plans may look like a new commercial payer channel if MCOs end up structuring their benefits and making
decisions differently compared to their employer-sponsored group plans. While we may not see significant differences in the
number of drugs covered compared to their current plans, MCOs may look to manage covered products more restrictively in the
» Patients enrolling in insurance exchanges may open more doors for patient assistance programs, especially if most patients
(as expected) enroll in the bronze plans that have high deductibles and copays
While it was indeed the federal government that passed the Affordable Care Act, it is important to consider that private MCOs
will continue to lead the way in ensuring appropriate care and implementing cost containment strategies for these patients.
Alex Gasik, is Director at Simon-Kucher. She can be reached at Alex.Gasik@simon-kucher.com
. Andy Ong is Senior Consultant at Simon-Kucher. He can be reached at Andy.Ong@simon-kucher.com
. Emma Nechamkin is Consultant at Simon-Kucher. She can be reached at Emma.Nechamkin@simon-kucher.com