Factbox: Winners, losers in Obama health proposal

(Reuters) - Health insurers, makers of brand-name drugs and generic drugmakers are among the industry players who see further pressure in U.S. President Barack Obama's healthcare proposal released on Monday.

The White House plans to hold a summit with Democratic and Republican congressional leaders on Thursday to discuss Obama's plan. Both the House of Representatives and the Senate have already passed separate bills aimed at overhauling the nation's $2.5 trillion healthcare system but have yet to agree on final legislation.

Overall, the S&P Health Care Sector Index was off 0.25 percent in afternoon trading compared to the overall S&P 500 Index's 0.07 percent drop.

Following are some of the changes healthcare industries face in the Obama administration's proposal, which was posted on the White House website here

LOSERS

HEALTH INSURERS

* Insurers such as WellPoint Inc, UnitedHealth Group Inc and Aetna Inc overall face increased regulations and payment cuts.

* Insurance plans would face a new federal Health Insurance Rate Authority to help U.S. states review "unreasonable rate increases and other unfair practices of insurance plans." Insurers would have to lower premiums, provide rebates or take other action if rate increases are found unjustified.

* Restrictions on companies are expanded in terms of prohibiting all annual and lifetime limits, and banning preexisting condition exclusions, among others.

* Private Medicare plans called Medicare Advantage would see payment changes that aim to compromise between the U.S. House of Representatives and Senate bills. Lower reimbursement rates for the plans, which can offer more benefits than traditional fee-for-service Medicare coverage at a higher cost, would be phased down over time toward traditional Medicare rates.

* Medicare Advantage plans would also see payment adjustments for unjustified billing practices.

* One small positive for health insurance companies: The 10-year $67 billion in new fees they already face in the Senate plan would be delayed until 2014.

* Shares of health insurance companies have fluctuated for months amid ongoing debate over healthcare reform. Industry shares were buoyed on Monday over a separate Medicare Advantage announcement on 2011 payment rates late Friday. The Morgan Stanley Healthcare Payor Index was up 1.5 percent while the S&P Managed Care Index was up 2.4 percent in afternoon trading.

BRAND-NAME DRUGMAKERS

* The brand-name pharmaceutical industry faces another $10 billion in fees over 10 years on top of its earlier agreement with the Senate Finance Committee to provide savings and rebates.

* The industrywide fees, to be parceled out among companies such as Pfizer Inc and Merck & Co Inc, will be used to eliminate a gap in Medicare's prescription drug coverage known as the "doughnut hole." That could help brand-name companies by getting patients to continue taking their medication rather than switching to a generic or stopping medication altogether.

* Obama also proposes greater scrutiny of prescription drug usage under the joint federal-state Medicaid health insurance program for the poor, requiring states to identify excessive medication use that could then save taxpayer dollars.

* In a positive move for the companies, the fees will be delayed by one year until 2011.

* Overall, shares of drug companies -- both brand and generics -- were off slightly more than the overall market on Monday, with the NYSE Arca Pharmaceutical Index down 0.6 percent.

GENERIC DRUGMAKERS

* Companies that make cheaper, generic versions of brand-name medicines would see an end to lucrative "pay-to-delay" settlements with brand-name drugmakers.

* Obama's measure gives the U.S. Federal Trade Commission authority to address the settlements and makes it illegal to pay generic manufacturers "to limit or forego research, development, marketing, manufacturing or sales of the generic drug."

* Exemptions would only be allowed if the companies can show their settlement would "outweigh the anti-competitive effects of the agreement."

WINNERS

DEVICE MAKERS

* Medical device makers such as Boston Scientific and Medtronic Inc maintained their earlier win of reducing their future taxes to $20 billion, down from $40 billion, and won a two-year delay for implementation until 2013.

* Obama's plan changes the structure of the taxes from a graduated fee to an excise tax. The shift could put smaller medical technology companies at greater risk depending on how it is implemented, according to analysts at Concept Capital's Washington Research Group.

(Reporting by Susan Heavey; Editing by Lisa Von Ahn, Phil Berlowitz)