How State Marketplaces
will affect pharma

This post is a part of our ACA Compliance in 2013 series.

State-by-state insurance exchanges, a key element of the Affordable Care Act (ACA) being introduced in 2014, are intended to broaden the pool of insured Americans and drive down healthcare costs.

These exchanges, also called State Marketplaces, provide the option for affordable health insurance through private companies to the millions of Americans whose jobs do not offer health benefits. The marketplace will also provide affordable options for small businesses that struggle to offer their employees health benefits.

While it might not be readily apparent that the insurance exchanges impact pharmaceutical manufacturers at all, they very likely will have a number of significant implications for government pricing, rebates, and incentives.

Some of the effects are still up in the air -- it’s not yet known, for example, how exchanges will impact government pricing, but manufacturers need to be prepared to quickly adapt to potential changes. Regardless, we do know that manufacturers will be forced to manage rebates or other incentives to some degree as a result of sales through these exchanges.

How will incentives be accommodated within existing or new calculations? This hybrid model -- private insurance sold through the states -- could prove rather dicey for an already overly interconnected pharmaceutical supply chain fraught with complex regulations.

Certainly at regulatory inflection points it’s crucial for manufacturers to make sure that they are managing their rebates and government pricing in an automated way, but what is even more important is a solution that allows for flexibility. Change is a constant in the pharmaceutical world, and an integrated compliance solution that can adapt to evolving regulations will help ensure a smoother transition to new compliance paradigms.

To learn more about impending elements of the ACA that will impact pharmaceutical manufacturers, including more information on health insurance exchanges, download our new e-book entitled “The Affordable Care Act in 2013.”