Table of Contents

Drug Pricing and Reimbursement Strategies: Preparing for the Coming Generic Onslaught

• Executive Summary

• Drug Pricing and Reimbursement: Strategic Overview

• Factors affecting Pharmaceutical Expenditur

• Key Issues and Challenges

• Pricing Strategies

• Regional Pricing Differences

• Scope and Methodology

• Reasons for Conducting the Study

• Drug Pricing and Reimbursement: Strategic Perspectives

• 2.1. Background

• 2.2. Global healthcare costs and their Impact on GDP

• 2.3. Drug Costs and Affordability

• 2.3.1. Price Variability across countries

• 2.4. Factors contributing to Drug Expenditures

• a) Volume Growth

• b) Rising Prices

• 2.5. Pharmaceutical Pricing and Ethics

• 2.5.1. Differential Pricing

• 2.5.2. HIV/AIDS Pricing & Ethics

• Pricing Strategies

• 3.1. Background

• 3.2. Pricing Strategies: Goals

• 3.2.1. Market Share

• 3.2.2. Defending Market share

• 3.2.3. New Customers

• 3.2.4. Enhancing Brand Loyalty

• 3.2.5. Improving Margins

• 3.2.6. Capacity Utilization

• 3.3. Pricing Decisions: Types

• 3.3.1. Traditional Pricing

• 3.4. Role of Pricing Function in Price setting

• 3.5. Pricing and Pharmacoeconomics

• 3.6. Price Optimization

• 3.7. Pricing in the Product Development Process

• 3.7.1. Background

• 3.7.2. The First Price Estimate

• 3.7.3. Improving Pricing in the Product Development Process

• Current Pricing and Reimbursement Trends in the USA

• 4.1.U.S. Healthcare Expenditures4.1.1. National Prescription Drug Expenditures

• 4.1.2 Pharmaceutical Costs

• 4.1.2.3. Factors for rise in pharmaceutical costs

• 4.1.3. Future trends in Pharmaceutical Costs

• 4.1.3.2. Increased Generic Penetration4.1.3.2. Rising Consumerism

• 4.1.3.4. Shifting Payor Mix

• 4.1.3.5. Cost Containment and the Formulary

• 4.1.3.6. Basis of price determination

• 4.2. Pricing mechanism in USA

• 4.3. Price Movement

• 4.3.1 Impact of Supply Chain on Price

• 4.3.2. Supply chain and price differentials

• Retail Sector

• Non retail sector

• 4.4. Key Pricing measures

• 4.4.1. Background

• a) Average Manufacturer’s Price (AMP)

• b) Average Sales Price (ASP)

• c) Average Wholesale Price (AWP)

• d) Estimated Acquisition Cost (EAC)

• e) Federal Supply Schedule.

• f) Federal Upper Limit (FUL)

• g) Maximum Allowable Cost (MAC)

• h) Wholesale Acquisition Cost (WAC)

• 4.5. Drug Pricing Litigations

• 4.6. Pricing Dynamics

• Single-Source Drugs

• Multiple-Source Drugs

• 4.7. Pricing and customer segments

• 4.7.1 Background

• 4.7.2 Pharmacy Benefit Managers

• Background

• PBM role

• Cost containment Strategies

• Pharmacies

• PBMs’ Negotiated Payments to Pharmacies

• PBMs’ Payments to Pharmacies

• 4.7.3. Mail-Order Pharmacies

• 4.7.4. Cash Customers

• 4.7.5. Government Markets

• 4.7.5.1. Federal Supply Schedule

• 4.7.5.2. 340B Drug Discount Program

• 4.7.5.3. Medicare

• a) PART A

• b) PART B

• Medicare Reimbursements

• c) Part C (Medicare Advantage)

• d) PART D

• Future Challenges

• 2008 Changes in Medicare Part D Payments

• Calculation of the Low-Income Benchmark Premium Amounts

• Annual Updates to Medicare Part D Benefit Parameters

• 4.7.5.4. Medicaid

• 4.7.6. Third party payors

• Managed care business structure

• Healthcare maintenance organizations (HMO)

• Point of service (PoS)

• Preferred provider organizations (PPO)

• MCOs and Pharmacy Benefit Managers (PBMs) relationships

• Co-payments and cost-reduction initiatives

• Managed Care Contracting: Pharmaceutical Manufacturers’ Perspective

• Managed Care Business Goals

• Managed Care Strategy

• 6. Monitoring Performance

• 4.7.7. Emerging Issues

• 4.7.7.1.Drug Price Transparency in United States

• 4.7.7.2. Wal-Mart and $4 Generics

• 4.7.7.3. Average Wholesale Price and First Data Bank

• Current Pricing and Reimbursement Trends in Europe

• 5.1. Background

• 5.1.1 EU Pricing Environment

• 5.1.2. Reimbursement Mechanisms

• 5.1.3. Pricing and Reimbursement impact on new product launch sequence

• 5.1.4. Drug Budgets

• 5.1.5. Pricing and Reimbursement Overview

• U.K. and Germany

• France, Italy and Spain

• 5.1.6. Parallel Trade

• Germany

• 5.2.1. Background

• 5.2.2. Statutory Health Insurance Funds

• 5.2.2.1.Reference Prices

• 5.2.3. Statutory Health Insurance Market

• FRANCE

• 5.3.1. Background

• 5.3.2. Regulatory Affairs in France

• 5.3.3. Regulations

• UK

• 5.4.1.Pricing System

• 5.4.2. Pricing of New Products

• 5.4.3. Pricing Methods for Generic Products

• 5.4.4. Reimbursement

• ITALY

• 5.5.1. Pricing Systems

• 5.5.2. Reimbursement

• SPAIN

• 5.6.1. Pricing Systems

• 5.6.2. Reference Pricing System

• 5.7.Tackling Parallel Trade

• Current Pricing and reimbursement Trends in Japan

• 6.1. Background

• 6.2. Japanese Healthcare System

• Employee’s Health Insurance Plan

• National Public Health Insurance Plan

• 6.2. Bungyo

• 6.3. Reimbursement system

• 6.3. The R-Zone and regular price decreases

Prescribing Pharmacists: A Decision Maker Emerges

Chapter One: Executive Summary

• Scope and Methodology

• Markets – Pharmacists Impact

• The Prescribing Pharmacist

• Main Drivers For Increased Pharmacist Prescription Authority

• Issues and Trends Shaping the Industry

• Methodology

Chapter Two: Introduction

• History and Description

• Role of the US Pharmacist

• Role in Distributing Controlled Substances

• Variations in Prescribing Authority

• Pharmacists Statistics

• Overview

• Earnings and Distribution by Employment Type

• State Concentrations

• Training and Certification

Chapter Three: Issues and Trends Shaping the Industry

• US Healthcare Expenditures

• Rising Healthcare Costs and Health Insurance Trends

• Pharmaceutical Trends

• Units Sales and Revenues of Top Branded Drugs

• Population Growth and the Existing Need

• Medication Safety

• Medication Errors

• Reducing Errors in Hospitals

• Drug Interactions

• Interactions and the Evolving Pharmaceutical Industry

• Prescribing Trends of Select Federal Programs

• State Comparison of Collaborative Practice

• Hospital Case Studies and Collaborative Drug Therapy Management

• HCA Hospitals

• Barriers to Collaborative Practice

• International Trends

• England

• Scotland

• Wales

• Northern Ireland

• Canada

• Japan

• Australia

Chapter Four: Pharmacist Impact on Pharmaceutical Markets

• Overview

• The Pharmacist Influence

• Influencing Drug Choice

• Influencing Drug Dosage, Administration, or Other Therapy Aspects

• Therapeutic Areas Most Influenced

• chapter Five: The Emerging Prescribing Pharmacist

• Differing Views on Increasing Roles of the Pharmacist

• Physicians’ View on Increasing Involvement in Prescribing

• Pharmacists’ View on Increasing Involvement in Prescribing

• States Most Likely to Implement Independent Prescribing

• Market Impact

APPENDIX: Nationwide Boards of Pharmacy

Table of Exhibits

Chapter One: Executive Summary

• Figure 1-1: Declining Drug Purchases Not Influenced By

• Pharmacist 2006-2012Table 1-1: Pharmacists Influence in Drug Selection and/or Therapy Aspect: 2006 and 2012

• Figure 1-2: Pharmacists Influence in Drug Selection and/or Drug Aspect, 2006 and 2012

Chapter Two: Introduction

• Table 2-1: Examples of Controlled Substances by Schedule

• Table 2-2: Number of Pharmacists in the Workforce 2004-2006

• Table 2-3: 2004 Median Annual Income Levels for U.S. Pharmacists

• Figure 2-1: 2004 Median Annual Income Levels for U.S. Pharmacists

• Table 2-4: 2005 Leading Employment Areas and Income Statistics for U.S. Pharmacists

• Table 2-5: 2006 Leading Employment Areas and Income Statistics for U.S. Pharmacists

• Figure 2-2: Number of Pharmacists (2005/2006) in Leading Employment Areas in the U.S.

• Figure 2-3: Mean Level of Income (2005/2006) for Leading Employment Areas in the U.S.

• Table 2-6: Pharmacist Concentrations for the Top Five States in 2006

• Figure 2-4: Pharmacist Concentrations for the Top Five States in 2006

• Table 2-7: Pharmacist Concentrations for the Top Five U.S. Metropolitan Areas in 2006

• Figure 2-5: Pharmacist Concentrations for the Top Five U.S. Metropolitan Areas in 2006

• Table 2-8: Number of Pharmacists Employed in all U.S. States, District of Columbia and U.S. Territories in 2006

• Figure 2-6: Top 20 States with the Most Pharmacists in the Workforce in 2006

• Table 2-9: Accredited Pharmacy Education Centers by State

Chapter Three: Issues and Trends Shaping the Industry

• Table 3-1: U.S. Prescription and Total Healthcare Expenditures 1995, 2000, and 2005

• Figure 3-1: U.S. Prescription and Total Healthcare Expenditures 1995, 2000, and 2005

• Table 3-2: Percent Insured in the U.S. by Income Level

• Figure 3-2: Percent Insured in the U.S. by Income Level

• Table 3-3: Health Insurance Trends in the United States 2003-2005

• Figure 3-3: Number Insured in the United States 2003-2005

• Table 3-4: Retail Pharmaceutical Sales in the U.S. 1995, 2000 and 2004

• Figure 3-4: Distribution of Retail Pharmaceutical Sales from 1995, 2000 and 2004

• Table 3-5: Top Ten Prescribed Branded Drugs by Estimated Unit Sales in the U.S.

• Table 3-5: Top Ten Prescribed Branded Drugs by Estimated Unit Sales in the U.S.

• Table 3-6: Top Ten Prescribed Branded Drugs and U.S. Revenues

• Figure 3-6: Top Ten Prescribed Branded Drugs and U.S. Revenues

• Table 3-7: Top Ten Prescribed Branded Drugs and Worldwide Revenues

• Figure 3-7: Top Ten Prescribed Branded Drugs and Worldwide Revenues

• Table 3-8: United States Population and Age Statistics

• Figure 3-8: United States Population and Age Statistics

• Table 3-9: Increase in the Oldest U.S. Population

• Figure 3-9: Increase in the Oldest U.S. Population

• Figure 3-10: Distribution of Fatal Prescribing Errors

• Table 3-10: Select 2007 Safety Alerts for Drugs and Therapeutic Biological Products

• Table 3-11: Drug Interaction Information

• Figure 3-11: Timeline of U.S. Pharmacy Collaboration

• Table 3-12: States That Allow Collaboration Agreements between Pharmacist and Physician

• Table 3-13: Pharmacists per Employment Category in Japan (2004)

Chapter Four: Pharmacist Impact on Pharmaceutical Markets

• Table 4-1: Pharmacists Influence in Drug Selection and/or Drug Therapy Aspect, 2006 and 2012

• Figure 4-1 : Pharmacists Influence in Drug Selection and/or Therapy Aspect, 2006 and 2012

• Table 4-2: Pharmacists Influence in the US Drug Market, Influencing Drug Choice, 2006

• Figure 4-2: Pharmacists Influence in the US Drug Market, Influencing Drug Choice, 2006

• Figure 4-3: Drug Markets Most Influenced by Pharmacists by Therapeutic Category, 2006

• Table 4-3: Pharmacists Influence in the US Drug Market, Influencing Drug Dosage, Administration, and Other Therapy Aspect, 2006

• Figure 4-3: Pharmacists Influence in the US Drug Market, Influencing Drug Dosage, Administration, and Other Therapy Aspect, 2006

chapter Five: The Emerging Prescribing Pharmacist

• Table 5-1: States Most Likely to Allow Prescription, Those to Follow, and States Not Likely to Allow Independent Prescribing

Growing “Out of Pocket” Healthcare Market (Spending on Surgeries, Pharmaceuticals and Other Healthcare Services), The

CHAPTER ONE: EXECUTIVE SUMMARY

• Out of Pocket Expenditures : Current Market

• The U.S. Healthcare Market

• The Need for Alternatives

• High Cost of Care

• Inconsistent Quality of Care

• Inaccessible Care

• Vulnerable Populations

• Consumers Who Pay Out of Pocket

• Medicaid Recipients

• Disabled Persons

• Senior Citizens

• The Mentally Ill

• Obese Persons

• Persons with Chronic Medical Conditions

• Health Care Reform

• Types Of Out Of Pocket Payments

• Insurance Co-Payments

• Direct Payments

• Premiums and Plan Fees

• Payment Methods

• Cash or Check

• Credit Cards

• Flexible Spending Accounts

• Loans and Lines of Credit

• Health Savings Accounts

• Health Care Financing

• Non-Elective Procedures and Prescription Drugs

• Types of Expenses Financed

• Elective Procedures

• Non-Elective Procedures and Prescription Drugs

• Trends In Out Of Pocket Spending

• Health Care Inflation

• Managed Care Cost Shifting

• Retail Clinics

• Disease Management Programs

• Medicare Prescription Drug Benefit

• Generic Drugs

• Rx-to-OTC Switches

• Medical Tourism

• Health Care Advisers

• Medical Procedure Financing

• Types of Procedures Financed

• Elective Procedures

• Non-Elective Procedures

• Financing Products

• Scope and Methodology

CHAPTER TWO: HEALTH CARE PAYMENTS AND COVERAGE

• Overview

• Public Health Care

• Private Health Care

• State-Licensed Health Insuring Organizations

• Commercial Health Insurers

• Blue Cross and Blue Shield Plans

• Health Maintenance Organizations

• Self-Funded Employee Health Benefit Plans

• Participation

• Cost Issues

• The Uninsured And Underinsured

• The Uninsured

• The Underinsured

• Regulation

• Health Care Reform

• Universal Federal Health Care Coverage

• State Health Care Coverage

• Current State Health Care Initiatives

• Federal Support of State Health Care Reform

CHAPTER THREE: OUT-OF-POCKET EXPENDITURES: THE CURRENT MARKET

• Overall Out-Of-Pocket Spending

• Payments Types

• Insurance Co-Payments

• Direct Payments

• Premiums and Plan Fees

• Payment Methods

• Cash or Check

• Credit Cards

• Flexible Spending Accounts

• Loans and Lines of Credit

• Health Savings Accounts

• Health Care Financing

• Amount Financed

• Elective Procedures

• Non-Elective Procedures and Prescription Drugs

• Consumers Who Pay Out Of Pocket

• Medicaid Recipients

• The Disabled

• Senior Citizens

• The Mentally Ill

• Obese Persons

• Persons with Chronic Conditions

CHAPTER FOUR: OUT-OF-POCKET EXPENDITURES: THE MARKET IN 2007-2011

• Trends

• Out-of-Pocket Expenditure Growth Drivers

• Health Care Inflation

• Managed Care Cost-Shifting

• Retail Clinics

• Services

• Pricing

• Consumer Response

• Expansion

• Out-of-Pocket Expenditure Growth Constraints

• Disease Management Programs

• Medicare Prescription Drug Benefit

• Generic Drugs

• Private-Label OTC Medications

• Rx-to-OTC Switches

• Medical Tourism

• Health Care Advisers

• Forecasts

• Payment Type

• Payment Methods

• Amount Financed

• Elective Procedures

• Non-Elective Procedures

• Consumers Who Pay Out of Pocket

CHAPTER FIVE: SOURCES OF MEDICAL PROCEDURE FINANCING, 2006

• Types Of Procedures Financed

• Elective Procedures

• Chiropractic Services

• Cosmetic Surgery

• Cosmetic Dentistry

• Elective Eye Procedures

• PRK Procedures

• LASIK Procedures

• LASEK

• Forecast

• Hair Restoration

• Fertility Treatments

• Weight Loss Surgery

• Non-Elective Procedures

• Financing Programs

• Costs to Consumers

• Costs to Providers

• Usage and Acceptance

• Key Players

• Elective Procedures

• Non-Elective Procedures

CHAPTER SIX: SOURCES OF MEDICAL PROCEDURE FINANCING, 2007-2011

• Trends

• Consumers

• Consumer Debt

• Payday Loans

• Weak Housing Market

• Widening Wage Gap

• Financial Awareness

• Security Concerns

• Financial Institutions

• Increasing Share of Wallet

• New Credit Card Products

• New Credit Card Customer Segments

• Forecasts

CHAPTER SEVEN: COMPANY PROFILES

• APFUSA

• Aurora Quick Care

• Capital One Healthcare Finance

• Care Credit

• Checkups

• Credit Medical

• CSI Financial Services

• Health Ready

• Medchoice Financial

• Meddirect

• Medprova

• Minuteclinic

• PFS

• Rediclinic

• Reliance Medical Finance

• Solantic

• Springstone Patient Financing

• Take Care Health Systems

• Target Clinical Medical Associates

TABLE OF EXHIBITS

CHAPTER ONE: EXECUTIVE SUMMARY

• Figure 1-1:The U.S. Out of Pocket Healthcare Market, 2006-2011, Elective and Non-Elective Spending (in billions)

• Figure 1-2: U.S. Consumer Out-of-Pocket Health Care Expenditures by Service Required, 2006

• Figure 1-3: U.S. Healthcare Consumers Highly Likely to Pay Out of Pocket, 2006-2011 (millions)

• Figure 1-4: U.S. Healthcare Consumers Likely to Pay Out of Pocket, by Contributing Factor 2006 (Persons with Chronic Conditions, Medicaid, Disabled, Senior Citizens, Mentally Ill, Obese)

• Figure 1-5 : Average Share Paid Out of Pocket by U.S. Consumers, by Percentile of Total Health Care Spending and Type of Service, 2003

CHAPTER TWO: HEALTH CARE PAYMENTS AND COVERAGE

• Figure 2-1: National Health Expenditures (NHE) and NHE as a Percentage of GDP, 1980-2011

• Figure 2-2: Premium Increases vs. Increases in Workers’ Earnings and Inflation, 1989-2005

• Table 2-1:Selected U.S. Federal and State Health Care Oversight Bodies,2007

• Table 2-2:U.S. Health Care Coverage by State,2007

CHAPTER THREE: OUT-OF-POCKET EXPENDITURES: THE CURRENT MARKET

• Figure 3-4: Average Share Paid Out-of-Pocket by U.S. Consumers, by Percentile of Total Health Care Expenses, 2003

• Figure 3-5: Average Amount Paid Out-of-Pocket by U.S. Consumers, by Percentile of Total Health Care Expenses, 2003

• Figure 3-1: U.S. Consumer Out-of-Pocket Health Care Expenditures: Direct Payments, Co-Pays and Premiums, 2006

• Figure 3-2: U.S. Consumer Out-of-Pocket Health Care Expenditures by Payment Type, 2006

• Table 3-1: Credit Card Debt of Consumers with Medical Debt by HealthInsurance Status,2007

• Table 3-2: Credit Card Debt of Consumers with Medical Debt by Demographic Group, 2007

• Figure 3-3: Methods of Payment for Elective Procedures, 2006

• Figure 3-4: U.S. Consumer Out-of-Pocket Spending for Elective Procedures, Amount Financed vs. Paid with Cash or Check, 2003

• Figure 3-7:Average Share of U.S. Health Care Expenses Paid Out of Pocket, by Type of Service, 2003

• Figure 3-8: Average Share Paid Out of Pocket by U.S. Consumers, by Percentile of Total Health Care Spending and Type of Service, 2003

• Figure 3-9: Distribution of Out-of-Pocket Spending on Non-Elective Procedures for the Average Person, 2003 71

• Figure 3-10: Distribution of Out-of-Pocket Spending for the Average Person, by Spending Level and Type of Service, 2003

• Figure 3-11: Drug Cost Coverage by Payor Type (Public, Private, Cash), 1965, 1986, 2000, 2004

• Figure 3-12: Change in Out-of-Pocket Health Care Expenses for Medicaid Recipients, 1997 to 2002

• Figure 3-13: Out-of-Pocket Health Care Expenses for Disabled and Non-Disabled Medicaid Recipients, 1997 vs. 2002

• Table 3-3: Obesity in the U.S., 1980-2011

• Figure 3-14: Adults Under Age 65 with Chronic Conditions by Type of Insurance, 2003

CHAPTER FOUR: OUT-OF-POCKET EXPENDITURES: FORECASTED MARKET TO 2011

• Figure 4-1: Extent to Which Consumers Believe Cost-Shifting Will Result in Beneficial Outcomes, 2003

• Figure 4-2: Growth of U.S. Retail Clinics, 2001-2011

• Table 4-1: Selected Rx-to-OTC Switches in the United States, 1982-2007

• Table 4-2: Rx-to-OTC Switch Candidates in the U.S., 2007-2012

• Table 4-3: Cost Savings From Medical Tourism for Various Procedures, 2007

• Table 4-4:U.S. Consumer Out-of-Pocket Expenditures per Worker, 2001-2011

• Table 4-5: U.S. Consumer Out-of-Pocket Expenditures by Payment Type, 2001-2011

• Figure 4-3: Distribution of U.S. Consumer Out-of-Pocket Spending by Payment Type, 2001, 2006, 2011

• Table 4-6:U.S. Consumer Out-of-Pocket Expenditures by Payment Method, 2001-2011

• Figure 4-4: Distribution of U.S. Consumer Out-of-Pocket Spending by Payment Method, 2001, 2006, 2011

• Table 4-7: Amount of U.S. Consumer Out-of-Pocket Expenditures for Elective Procedures , 2001-2011 (in billion $)

• Figure 4-5: Share of U.S. Consumer Out-of-Pocket Spending for Elective Procedures Paid for Through Financing, 2006-2011

• Table 4-8: Amount of U.S. Consumer Out-of-Pocket Expenditures for Non-Elective Procedures , 2001-2011 (in billion $)

• Figure 4-6: Distribution of Out-of-Pocket Spending on Non-Elective Procedures for the Average Person, 2006 vs. 2011

• Figure 4-7: Share of U.S. Consumer Out-of-Pocket Spending for Non-Elective Procedures Paid for Through Financing, 2006-2011

• Table 4-9: Size of High-Risk Groups for High Out-of-Pocket Health Care Expenditures, 2001-2011 (in millions)

CHAPTER FIVE: SOURCES OF MEDICAL PROCEDURE FINANCING, 2006

• Figure 5-1:Distribution of Medical Procedure Financing Market, 2006

• Table 5-1:Cosmetic Surgical Procedures Offered in the U.S., 2007

• Table 5-2: Firtility Treatments in the U.S., 2007

• Table 5-3:Leading Weight Reduction Surgeries Offered in the U.S., 2007

• Table 5-4:Comparison of Selected Medical Financing Program Costs to Consumers, 2006

• Table 5-5:Selected Elective Procedures Covered by Leading Medical Financing Companies, 2007

• Figure 5-2:Leading Players’ Share of U.S. Elective Procedure Financing Market, 2006

• Table 5-6:Selected Non-Elective Procedures Covered by Leading Medical Financing Companies, 2007

• Figure 5-3:Leading Players’ Share of U.S. Elective Procedure Financing Market, 2006

CHAPTER SIX: SOURCES OF MEDICAL PROCEDURE FINANCING, 2007-2011

• Table 6-1: Consumer Out-of-Pocket Expenditures for Elective Procedures Paid Through Patient Financing Programs, 2001-2011 (in billion $)

• Table 6-2: Consumer Out-of-Pocket Expenditures for Non-Elective Procedures Paid Through Patient Financing Programs, 2001-2011 (in billion $)

• Figure 6-1: Consumer Out-of-Pocket Expenditures for Elective and Non-Elective Procedures Paid Through Patient Financing Programs, 2001-2011 (in billion $)

• Figure 6-2: Proportion of Consumer Out-of-Pocket Spending for Elective Procedures Paid Through Patient Financing Programs, 2006-2011

Retail Clinics, The Emerging Market for Convenience and In-Store Healthcare

CHAPTER ONE: Executive Summary

• Healthcare Reform

• The Emergence of Retail Clinics

• Establishing a Retail Clinic

• Service Providers

• Suppliers

• Clinical Chemistry and Immunoassays

• Vaccines

• Indirect Revenues

• Types of Retail Outlets Offering Clinics

• Drug Stores

• Supermarkets and Food Stores

• Mass Merchandisers

• Other Outlets

• Issues And Trends

• Competition with Primary Care Providers

• Regulation

• Development of Standards

• Expansion of Services

• Labor Shortages

• Scope and Methodology

CHAPTER TWO: Introduction

• The U.S. Healthcare System Today

• Overview

• Public Health Care

• Private Health Care

• The Need For Alternatives

• High Cost of Care

• Inconsistent Quality of Care

• Delays to Treatment

• Advertising and Promotion

• Insurance

• Consumer Response

• Growth Drivers

• Economic Pressures on Consumers

• Consumer Responsibility for Health Care

• Benefits of Prevention

• Challenges

• Standards of Care

• Patient Flow

• Medical Community Response

• Reaction from Managed Care Organizations

• Ability to Meet Financial Expectations

• Establishing A Retail Clinic

• Alliances

CHAPTER THREE: Service Providers

• The Industry

• Convenience Clinic Sales Forecasts

• The Market

• Competitive Positions of Key Players

CHAPTER FOUR: OPPORTUNITIES FOR DIAGNOSTIC AND PHARMACEUTICAL COMPNIES

• Point of Care Tests

• The Industry

• Competitive Positions of Key Players

• Convenience Clinic Sales Forecasts

• Clinical Chemistry and Immunoassays

• The Industry

• Competitive Positions of Key Players

• Convenience Clinic Sales Forecasts

• Vaccines

• The Industry

• Competitive Positions of Key Players

• Convenience Clinic Sales Forecasts

CHAPTER FIVE: Retail Outlets

• Drug Stores

• The Industry

• Competitive Positions of Key Players

• Convenience Clinic Sales Forecasts

• Food Stores

• The Industry

• Competitive Positions of Key Players

• Convenience Clinic Sales Forecasts

• Mass Merchandisers

• The Industry

• Competitive Positions of Key Players

• Convenience Clinic Sales Forecasts

• Other Outlets

• The Industry

• Competitive Positions of Key Players

• Convenience Clinic Sales Forecasts

CHAPTER SIX: Total Market

• Growth of Retail Clinics

• Opportunities for Suppliers

• Increased Revenue for Retailers

CHAPTER SEVEN: Issues and Trends

• Competition With Primary Care Providers

• Regulation

• Overview

• Regulation of Convenience Clinics

• Pending Legislation

• Development of Standards

• Expansion of Services

• Labor Shortages

CHAPTER EIGHT: Company Profiles

• Atlanticare

• Aurora Quick Care

• Checkups

• Early Solutions Clinic

• MedBasics

• Minute Clinic

• My Healthy Access

• Quick Health

• Now Medical Centers

• Rediclinic

• SmartCare Family Medical Centers

• Solantic

• Take Care Health Systems

• Target Clinic Medical Associates

• The Little Clinic

• Appendix

TABLE OF EXHIBITS

CHAPTER ONE: EXECUTIVE SUMMARY

• Figure 1-1: Estimated Number of U.S. Convenience Clinics, 2007 – 2011

• Figure-1-2: Locations of Retail Clinics, 2007

• Figure 1-3: Indirect Revenue to Drug Stores, Supermarkets, Mass Merchandising Outlets and Others with Retail Clinics

CHAPTER TWO: INTRODUCTION

• Figure 2-1: National Health Expenditures (NHE) and NHE as a Percent of GDP, 1980 – 2011

• Figure 2-2: Premium Increases vs. Increases in Workers Earnings and Prices, 1989 – 2005

• Figure 2-3: Unnecessary Deaths Resulting From Variations in Health Care Quality

• Figure 2-4: HEDIS Scores by Quality of Health Care Plan, 2006

• Figure 2-5: Change in Out of Pocket Health Care Expenses for Medicaid Recipients, 1997 – 2002

• Figure 2-6: Out of Pocket Health Care Expenses for Disabled and Non-Disabled Medicaid Recipients, 1997 vs. 2002

• Figure 2-7: Proportion of Adults Under Age 65 With Chronic Conditions, 2003

• Table 2-2: U.S. Health Care Coverage by State, 2007

• Table 2-3: Cost Savings From Medical Tourism, 2007

• Table 2-4: Estimated Number of U.S. Convenience Clinics, Expansion of U.S. Convenience Clinics by Major Chain (Aurora, QuickCare, Healthy Access, Minute Clinic, Quick Health, Solantis, Target Clinical, CheckUps, MedBasics, Now Medical Centers, RediClinic Others, Take Care Clinics, the Little Clinic) 2007 to 2011

• Figure 2-8: Expansion of U.S. Convenience Clinics by Major Chain (Aurora QuickCare, Healthy Access, Minute Clinic, Quick Health, Solantis, Target Clinical, CheckUps, MedBasics, Now Medical Centers, RediClinic Others, Take Care Clinics, the Little Clinic) 2007 to 2011

• Table 2-5: Characteristics of Retail Outlets, 2007 (Drug Stores, Food Stores, Mass Merchandizing Outlets)

• Table 2-6: Benefits and Drawbacks of Convenience Clinic Funding Approaches, 2007

• Table 3-1: The U.S. Market for Retail Clinic Services, 2001-2011

CHAPTER THREE: SERVICE PROVIDERS

• Figure 3-1: Growth of U.S. Retail Clinic Services, 2001-2011

• Table 3-2, Leading Service Providers’ Revenues and Market Share

• Figure 3-2: Market Shares of Leading Retail Clinic Service Provider, 2006

CHAPTER FOUR: OPPORTUNITIES FOR DIAGNOSTIC AND PHARMACEUTICAL COMPNIES

• Table 4-1: Sales to Retail Clinics by Supplier Segment, 2001-2011 (POC Tests, Clinical Chemistry & Immuno-assays, Vaccines)

• Figure 4-1: Growth of Retail Clinic Supplier Sales by Type of Supplies, 2001-2011 (POC Tests, Clinical Chemistry & Immuno-assays, Vaccines)

• Table 4-2: U.S. Professional POC Test Sales, 2001-2011

• Table 4-3: Leading POC Test Makers’ U.S. Revenues and Markert Share, 2006

• Table 4-4: U.S. Professional POC Test Sales to Retail Clinics, 2001-2011

• Table 4-5: U.S. Clinical Chemistry and Immunoassay Sales, 2001-2011

• Table 4-6: Leading Clinical Chemistry and Immunoassay Suppliers’ Revenues and Market Share, 2006

• Table 4-8: Diseases for which Vaccines are Available in the U.S., 2007

• Table 4-9: U.S. Market for Preventative Vaccines, 2001-2011

• Table 4-10: Leading Vaccine Manufacturers’ U.S. Revenues and Market Share, 2007

• Table 4-11: U.S. Vaccine Sales to Convenience Clinics, 2001-2011

CHAPTER FIVE: RETAIL OUTLETS

• Table 5-1: Number of Retail Clinics by Type of Retail Outlet (Drug Stores, Supermarkets, Mass Merchandising Outlets, Other), 2001-2011

• Figure 5-2: Proportion of Rents Collected From Retail Clinics by Type of Retail Outlet, 2001-2011 (Drug Stores, Supermarkets, Mass Merchandising Outlets, Others)

• Table 5-3: Indirect Income Generated by Retail Clinics by Type of Retail Outlet, 2001-2011, (Drug Stores, Supermarkets, Mass Merchandising Outlets, Others)

• Figure 5-3: Proportion of Indirect Income Generated by Retail Clinics by Type of Retail Outlet, 2001-2011 (Drug Stores, Supermarkets, Mass Merchandising Outlets, Others)

• Table 5-4: Selected Retail Outlet Relationships with Convenience Clinics, 2007

• Table 5-5: U.S. Drug Store Sales, 2001-2011

• Table 5-6 Leading U.S. Drug Stores’ Revenues and Market Share, 2006

• Table 5-7: U.S. Drug Store Direct Retail Clinic Revenues, 2001-2011 (No. of Stores, Sq. Ft Per Store, Cost Per Sq. Ft.)

• Table 5-8: U.S. Drug Store Indirect Retail Clinic Revenues, 2001-2011 (Number of Clinics, Patients/Clinic/Day, Incremental Sales per Patient, Total Indirect Revenue)

• Figure 5-4: Direct vs. Indirect Revenues to Drug Stores From Retail Clinics, 2001-2011

• Table 5-9: U.S. Food Store Sales, 2001-2011

• Table 5-10: Leading Food Stores Revenues and Market Share, 2006

• Table 5-11: U.S. Food Stores Direct Retail Clinic Revenues, 2001-2011 (No. of Stores, Sq. Ft Per Store, Cost Per Sq. Ft.)

• Table 5-12: U.S. Food Store Indirect Retail Clinic Revenues, 2001-2011 (Number of Clinics, Patients/Clinic/Day, Incremental Sales per Patient, Total Indirect Revenue)

• Figure 5-5: Direct vs. Indirect Revenues to Food Stores from Retail Clinics, 2001-2011

• Table 5-13: U.S. Mass Merchandiser Sales, 2001-2011

• Table 5-14: Leading Mass Merchandisers Revenues and Market Share, 2006

• Table 5-15: U.S. Mass Merchandiser Retail Clinic Revenues (No. of Stores, Sq. Ft Per Store, Cost Per Sq. Ft.)

• Table 5-16: U.S. Mass Merchandiser Indirect Retail Clinic Revenues, 2001-2011 (Number of Clinics, Patients/Clinic/Day, Incremental Sales per Patient, Total Indirect Revenue)

• Table 5-17: U.S. Other Retail Sales, 2001-2011

• Table 5-18: Leading Other Outlets Revenues and Market Share, 2006

• Table 5-19: US Other Outlets Direct Retail Clinics Revenues (No. of Stores, Sq. Ft Per Store, Cost Per Sq. Ft.)

• Table 5-20: U.S. Other Outlets Indirect Retail Clinic Revenues (Number of Clinics, Patients/Clinic/Day, Incremental Sales per Patient, Total Indirect Revenue)

CHAPTER SIX: MARKET SUMMARY

• Table 6-1: Retail Clinic Service Revenues, 2001-2011

• Table 6-2: Sales to Retail Clinics by Suppliers 2001-2011

• Figure 6-1: Revenues from Retail Clinics (Direct Rents/Indirect Revenues)

CHAPTER SEVEN: ISSUES AND TRENDS

• Table 7-1: Selected U.S. Federal and State Health Care Oversight Bodies, 2007

Return of the Rx to OTC Switch: Market Analysis and Product Management Strategies, The

CHAPTER ONE: EXECUTIVE SUMMARY

• Scope of the Report

• Methodology

• Issues and Trends

CHAPTER TWO: RX-TO-OTC PRODUCT AND MARKET ANALYSIS

• Introduction

• Allergy and Cold

• Market Analysis

• Antilipidemic Agents

• Market Analysis

• Fungal Infections

• Market Analysis

• Gastrointestinal

• Market Analysis

• Hair Loss

• Market Analysis

• Migraine Therapy

• Market Analysis

• NSAIDs

• Market Analysis

• Oral Contraceptives

• Market Analysis

• Osteoporosis and Hormone Replacement Therapy

• Market Analysis

• Overactive Bladder

• Market Analysis

• Sexual Dysfunction

• Viagra

• Market Analysis

• Sleep Agents

• Ambien

• Lunesta

• Provigil

• Market Analysis

• Smoking Cessation

• Nicotrol Inhalation and Nasal Spray

• Zyban

• Market Analysis

• Viral Infections

• Tamiflu

• Valtrex

• Market Analysis

• Others

• ReVia

• Market Analysis

CHAPTER THREE: ISSUES AND TRENDS AFFECTING THE RX-TO-OTC SWITCH INDUSTRY

• Proposed Legislation

• Consumers and Rx-to-OTC Switches

• Direct-to-Consumer (DTC) Advertising

• Patient Safety

• FDA Again Considering Third Class of Medicines

• Insurance Reimbursement Issues

• OTC Switch Criteria and FDA Involvement

• Competition Strategies

TABLE OF EXHIBITS

CHAPTER ONE: EXECUTIVE SUMMARY

• Figure 1: Major Markets for Rx to OTC 2008 and 2010

• Figure 2: Number of New Rx-to-OTC Switches per Year 1976-2007

CHAPTER TWO: RX-TO-OTC PRODUCT AND MARKET ANALYSIS

• Figure 3: Revenue, Major Rx to OTC Categories, 2008

• Table 1: Potential Rx-to-OTC Switches, 2008-2013

• Table 2: Rx-to-OTC Market Analysis: Allergy and Cold Treatments

• Table 3: Rx-to-OTC Market Analysis: Antilipidemic Agents

• Table 4: Rx-to-OTC Market Analysis: Fungal Infection Treatments

• Table 5: Rx-to-OTC Market Analysis: Gastrointestinal Treatments

• Table 6: Rx-to-OTC Market Analysis: Hair Loss Treatments

• Table 7: Rx-to-OTC Market Analysis: Migraine Therapies

• Table 8: Rx-to-OTC Market Analysis: NSAIDs

• Table 9: Rx-to-OTC Market Analysis: Oral Contraceptives

• Table 10: Rx-to-OTC Market Analysis: Sleep Agents

• Table 11: Rx-to-OTC Market Analysis: Smoking Cessation

CHAPTER THREE: ISSUES AND TRENDS AFFECTING THE RX-TO-OTC SWITCH INDUSTRY

• Table 12 Leading Rx-to-OTC Switches 1994-2007

• Figure 1: Number of New Rx-to-OTC Switches per Year 1976-2007

• Table 13: Health Insurance Trends in the United States 2003-2006