PHP60 - PAYER ARCHETYPING – EXPANDING HORIZONS

Abstract

The traditional pharmaceutical market model is being challenged by the emergence of middle-income countries with rapidly growing economies, healthcare coverage, and willingness-to-pay for medicines. Understanding how these emerging markets determine appropriate pricing and reimbursement for public healthcare coverage of new therapies will thus become increasingly important considerations for global product launches. This research aims to analyse pricing and reimbursement processes across a broad range of markets and archetype these into groups based on commonalities in key decision-drivers. 30 countries were selected based on their total healthcare expenditure (using World Health Organisation data). Publically-available information on the reimbursement processes and decision-making criteria were identified from the relevant sources and supplemented with internal expertise, which were grouped into archetypes based on commonalities. Four payer archetypes for public healthcare technology reimbursement were identified and countries were classified into: cost-effectiveness driven, budget impact driven, competitive tendering driven, and clinical-benefit driven. Of the markets assessed, 27% (9/30) were cost-effectiveness driven (Australia, Canada, Colombia, Ireland, Netherlands, England, Republic of Korea, and Sweden), 50% (15/30 were budget impact driven (Argentina, Austria, Brazil, Chile, China, Finland, Indonesia, Iran, Israel, Italy, Mexico, Poland, Russian Federation, South Africa and Spain), 7% (2/30) were competitive tendering (the USA and India), and 17% (5/30) were clinical-benefit driven (Belgium, France, Germany, Japan, Switzerland). Optimal pricing and reimbursement in emerging markets is becoming increasingly important in determining the global commercial success of new medicines. This research identifies common criteria from their diverse pricing and reimbursement processes and groups these into discrete archetypes. Utilizing these groupings can better enable companies to appropriately and efficiently develop strategic decision-making, evidence generation, and communication plans that can be inclusive of the needs of emerging markets.