WASHINGTON (Reuters) - The healthcare reform measure passed by the House of Representatives on Sunday delivers some good news for drugmakers, device companies and even health insurers.
Among the changes in the legislation was a provision delaying hefty taxes on those three industries by at least a year.
Following are some of the winners and losers in the overall healthcare industry based on a Senate version of the bill and the reconciliation bill passed by the House on Sunday.
The Senate must vote on the reconciliation bill, so changes could still emerge.
* The pharmaceutical industry keeps its $80 billion agreement to provide savings and rebates. Its fees, to be divided among companies such as Pfizer and Merck & Co, would be delayed from 2010 to 2011, increasing from the initial $2.3 billion a year to $2.7 billion.
* Overall, wider insurance coverage could help offset the costs by providing more potential customers.
* Drugmakers warded off deeper price cuts in the Medicare program for the elderly. The House had sought to fully close the so-called “doughnut hole” where coverage drops temporarily after reaching a certain limit, but the bill maintains the industry’s 50-percent discount. The government will pay for another 25-percent discount.
* Lawmakers rejected Obama’s plan to end lucrative “pay-for-delay” settlements with brand-name drugmakers, a win for both generic and brand-name companies.
* The bill also discards an earlier provision that would have extended a hospital drug discount program.
BRAND BIOLOGIC DRUGMAKERS
* While the bill sets up a regulatory path for generic versions of expensive biologic drugs, Amgen and Roche’s Genentech unit and other biological drugmakers won a 12-year period of exclusive sales for brand-name drugs before facing competition from generic rivals.
* Fees for medical device makers, such as Boston Scientific and Medtronic, would be delayed to 2013 after initial bills called for 2010. The sector earlier won a reduced industry tax of $20 billion, down from $40 billion.
* Rather than an overall industry fee, the bill now contains a 2.9 percent sales tax. Certain consumer products, including eyeglasses and contact lenses, are exempt.
* Hospitals, which include companies such as Universal Health Services and Tenet Healthcare, say they kept a $155 billion, 10-year deal to accept lower government payments from Medicare and Medicaid in exchange for an expected boost in insured customers.
* A provision that could have helped certain rural and children’s hospitals with an expanded drug discount program was dropped.
PHARMACY BENEFIT MANAGERS
* Analysts say increased Medicare drug coverage could boost pharmacy benefit managers (PBM) that administer prescription drug benefits as companies, such as Express Scripts and Medco Health Solutions, could see increased volumes.
* PBMs still face more disclosures but not new taxes. Companies must give the Department of Health and Human Services information about rebates from drugmakers for certain drugs.
* While health insurers overall still face tighter regulation, companies such as Aetna Inc, Cigna Corp, UnitedHealth Group Inc and WellPoint Inc saw their $67 billion, 10-year tax delayed until 2014.
* Private Medicare plans called Medicare Advantage would see their payments frozen in 2011, then lowered in 2012. The plans, which can offer more benefits than traditional Medicare coverage, would also have to spend at least 85 cents out of every dollar on medical costs -- leaving 15 cents toward overhead and salaries, among other things.
* Consumer protection rules would change the way companies do business, banning denial of coverage for preexisting medical conditions and ending lifetime coverage limits. Some curbs would be expanded to all health insurance plans six months after the bill passes, while others take effect in 2014.
* The bill changes penalties for individuals who do not buy health insurance as mandated. The fine is lowered from $495 to $325 in 2015 and from $750 to $695 in 2016, but the alternative method of fining people using a percentage of income increased slightly to 2.5 percent by 2016.
* The bill does not include President Barack Obama’s call for federal oversight of health insurance rates. It also expands tax credits and other financing to help more people afford insurance.
* Lawmakers have said roughly 30 million more Americans could have insurance with the reform.
* The 12-year period of exclusive brand-name sales of biologic drugs surpasses the 5-7 years proponents had sought.
* Overall, companies that make generic versions of brand-name drugs see little direct help, although increasing insurance access may help more people buy medicine.
* But the bill includes a 75-percent discount on generic drugs in Medicare, the same as on brand-name drugs. Companies were concerned that closing the Medicare “doughnut hole” would turn people away from cheaper, generic medicines.
TANNING BED MAKERS
* The bill keeps a 10-percent tax on consumers who use indoor tanning salons, seeking to raise $2.7 billion by 2019 while discouraging a practice that can cause skin cancer.
Reporting by Susan Heavey; editing by Paul Simao
Our Standards: The Thomson Reuters Trust Principles.