Obama's re-elected. So what's next for pharma?

To call the 2012 election a referendum on Obamacare would be reductionist. But the Affordable Care Act's survival is, no question, the most obvious and specific consequence of President Obama's re-election, and the Democrats' hold on a Senate majority. Yesterday, there was a possibility that a President Romney would start chipping away at healthcare reform from Day One. Today, our two-term president can add it to his Legacy file.

The pharma industry knows well what this means. The fees and rebates negotiated back in 2009 are here to stay. In 2014, the individual mandate takes effect, putting millions more people onto health insurance rolls. Just how many we're not sure--will states that balked at Medicaid's expansion really follow through on their threats to opt out? But there's no doubt pharma will gain some sales from the deal.

Whether those additional sales will compensate for the extra fees is another question. Drugmakers heavily exposed to Medicaid, such as Eli Lilly ($LLY), will be hoping for few opt-outs. When the Supreme Court upheld the individual mandate earlier this year, some industry analysts figured the newly insured would fill the fee-and-rebate gap. Others weren't so sanguine; they predicted a net loss.

Long term, it could well be a wash. But Obama's re-election could revive some threatening proposals. Price negotiation rights for Medicare is one. Re-importation of drugs is another. Killing the tax deduction for direct-to-consumer advertising is a third.

Other immediate questions: Will FDA Commissioner Margaret Hamburg stick around? The consensus feeling is that she will, which probably means continued close scrutiny for manufacturers--and continued focus on stepping up the pace of drug approvals. And will Congress push us over the fiscal cliff? If so, then FDA will have to come up with more than $300 million in budget cuts--which probably means layoffs--and pharma will have to brace for an across-the-board reduction in Medicare reimbursements.

One last thought: Social-media advocates have been pushing drugmakers toward Facebook, Twitter, and other online venues where they can engage patients (and doctors) directly. Some have bought the idea more than others. The reluctant may want to consider this: When the TV networks called the election for Obama, his first personal, public response was a tweet: "We're all in this together. That's how we campaigned, and that's who we are. Thank you. -bo" News anchors' response was a stating of the obvious: The world has changed.

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