FACTBOX-Winners, losers in U.S. Senate health bill

 (Full coverage of U.S. health reform at [ID:nN20512341])
 WASHINGTON, Dec 21 (Reuters) - Makers of brand-name drugs,
medical devices and cosmetic treatments as well as suppliers of
home health care services are among the industry winners in the
U.S. Senate's sweeping healthcare reform bill.
 The Senate is expected to approve the $871 billion, 10-year
legislation by Thursday.
 Negotiators will then blend the Senate's language with a
version approved by the U.S. House of Representatives on Nov.
7. It is unclear how long negotiations will take given some
substantial differences between the Senate and House versions.
 Following are some of the health industry winners and
losers based on the Senate bill.
 * The pharmaceutical industry kept intact its $80 billion
agreement with the Senate Finance Committee to provide savings
and rebates, including a $2.3 billion annual industry fee to be
parceled out among companies such as Pfizer Inc PFE.N and
Merck & Co Inc MRK.N. Wider insurance coverage could help
offset the costs by providing more potential customers.
 * Drug companies overcame an attempt to allow consumers to
import cheaper medicines from other countries such as Canada.
Senators rejected two related amendments.
 * Drugmakers also avoided House bill provisions calling for
bigger rebates under the government's low-income Medicaid
insurance program and price negotiations in the Medicare
program for the elderly.
 * However, top Senate Democrats aim to eliminate a gap in
Medicare's prescription drug coverage known as the "doughnut
hole." While the Senate bill calls for a 50 percent reduction
in the gap, senators said they will seek more changes during
negotiations with the House, which wants to eliminate the
entire gap by 2019.
 * The bill also creates a stronger Independent Medicare
Advisory Board to recommend Medicare payments for private drug
insurance plans, which could in turn impact prescription drug
 * Medical device makers such as Boston Scientific BSX.N
and Medtronic Inc MDT.N earlier won a big reduction in an
industry tax to $20 billion, down from $40 billion, to conform
with the House bill.
 * Senate Majority Leader Harry Reid's amendment offered on
Saturday also delayed the tax by a year until 2011. Device
makers had sought to eliminate the tax and are now pushing for
a delay until 2013.
 * Hospitals, including companies such as Universal Health
Services Inc UHS.N and Tenet Healthcare Corp THC.N,
retained a $155 billion, 10-year deal accepting lower
government payments from Medicare and Medicaid in exchange for
what the industry hopes will be a boost in insured customers.
 * The industry also kept an exemption from the Independent
Medicare Advisory Board, insulating it from recommended future
payment cuts from the panel.
 * Amgen Inc AMGN.O and Roche's ROG.VX Genentech unit
and other biological drugmakers won a 12-year period of
exclusive sales for brand-name drugs before facing competition
from generic rivals.
 * The bill calls for creating user fees that generic
biologic drugmakers would pay to the FDA to review their
products. This could put them on par with brand-name biologic
drugmakers but keep some generic companies from pursuing rival
products. Traditional generic drugmakers do not currently face
such fees though they are under consideration.
 * The bill would reimburse doctors 6 percent more for using
generic biologic drugs over costly, branded ones. That could
affect their use among the tens of millions of Medicare and
Medicaid patients.
 * Reid's amendment dropped a 5 percent tax on elective
cosmetic procedures such as Botox injections to smooth
wrinkles, breast enlargements and tummy tucks that could have
cut sales for companies such as Allergan Inc AGN.N and
Johnson & Johnson's Mentor unit. The bill instead levies a 10
percent tax on consumers who use indoor tanning salons to raise
$2.7 billion by 2019.
 * Providers of home health care would see smaller payment
cuts that are also imposed more gradually. That could be good
news for companies such as Amedisys Inc AMED.O, Addus
HomeCare Corp ADUS.O and Gentiva Health Services Inc GTIV.O
that provide services in patients' homes.
 * The bill would delay by one year, until 2014, changes to
reimbursement rates.
 * Various analysts estimated the payment cuts at $39
billion over 10 years in the final bill, instead of original
payment cuts of $42.1 billion.
 * Insurers such as WellPoint Inc WLP.N, UnitedHealth
Group Inc UNH.N and Aetna Inc AET.N overall will face a
host of tighter regulations, higher taxes and caps on profits.
 * Insurance plans for large groups would have to spend at
least 85 cents out of every dollar on medical costs -- leaving
15 cents toward overhead and salaries, among other things.
Small groups or individual plans would have to spend at least
80 cents per dollar on care. That proportion of spending, known
as a "medical loss ratio," has varied widely and is closely
watched by Wall Street due to its impact on profits.
 * Private Medicare plans called Medicare Advantage would
see roughly $118 billion in cuts over 10 years, according to
various analysts. Reimbursement rates for the plans, which can
offer more benefits than traditional fee-for-service Medicare
coverage at a higher cost, would be tied to a competitive
bidding process.
 * New consumer protection provisions will change the way
companies do business. They include banning preexisting medical
conditions and ending limits on how much coverage patients can
get from their insurers over their lifetime.
 * The new Medicare advisory panel could recommend lower
payments to private prescription "Part D" plans operated by a
number of insurers.
 * There are some bright spots for the industry: A
government-run health insurance option was dropped from the
Senate bill amid heavy lobbying by insurers, although the House
version still includes a such a plan -- often called a "public
 * Costlier penalties for individuals who do not buy health
insurance as mandated were included in the final Senate
version, which could boost the number of people who opt for
insurance. Penalties could now be as high as 2 percent of a
household's income, compared to a previous plan to phase in the
penalty to reach $750 by 2017.
 * Companies that make cheaper, generic versions of
brand-name medicines see little direct help from the Senate
bill, although increasing access to health insurance could help
more people overall access to prescription medicines.
 * While the bill sets up a regulatory path for generic
versions of expensive biologic drugs, it also grants brand-name
biologics exclusive sales for 12 years. That is a substantial
shift from the 5-7 years proponents had sought.
 * Efforts to close the Medicare "doughnut hole" could also
impact generic drug use. Because Medicare patients now pay full
price for a certain period under the coverage gap, a number of
patients switch to available generics until coverage kicks back
in and the industry says some customers then stay with a
generic even when coverage returns.
 * Pharmacy benefit managers, which administer prescription
drug benefits, face more disclosures. Under the bill, companies
such as Medco Health Solutions Inc MHS.N, Express Scripts Inc
ESRX.O and CVS Caremark Corp CVS.N must give the Department
of Health and Human Services information about rebates they get
from drugmakers for medications sold through retail and
mail-order pharmacies compared to those through Medicare drug
 * The sector was not targeted with any new taxes under the
Senate bill, but Wall Street analysts are still concerned given
the uncertainty that a tax could be added during House-Senate
 * Nursing homes, which care for patients who are not quite
sick enough for a hospital, would see a 1-year delay of a new
payment system that would affect how they classify patients and
receive reimbursement to 2011 instead of 2010.
 * However, provisions that limit how many patients a
therapist can oversee at one time would start in 2010 and could
affect costs and staffing at nursing homes. Such facilities are
run both by nonprofit organizations as well as companies such
as Skilled Healthcare Group Inc SKH.N and Kindred Healthcare
Inc KND.N.
  (Reporting by Susan Heavey; editing by Andre Grenon)