A Payers Perspective to Pharmaceutical Market Access: Defining Market Access

Abstract

Objectives: The aim of the study is to analyze the burden of chronic diseases on public health care expenditures using pharmaceutical data regarding about 2 million individuals. MethOds: Data come from the administrative database of the third Belgian health insurance funds. Without explicit diagnoses of diseases in the database, chronic diseases are mainly estimated using drugs prescription (reimbursed medications only) for a treatment of at least 90 days/year. A multivariate linear model based on the OLS method is used to analyse the impact of 23 chronic diseases on health care expenditures, while controlling for age, sex, marital and social status, share of hospital expenditures, residential areas and year of death. Results: Monthly average health care costs for people with one or more chronic conditions is 6 times greater than the ones without any chronic conditions (€ 423 vs. € 71). All chronic diseases (except psoriasis) have a significant impact on health care (at 1% level). The last months of life, developing or living with cancer, chronic renal failure, rare disease and mental disorder are the factors having the greatest impact on monthly reimbursed health care expenditures. All things being equal, a person at the end of life costs more than € 2,236 per month to the health insurance compared to a person not at the end of life. Respectively this amounts to € 3,557, € 3,008, € 2,042 and € 1,151 for people living with a rare disease, chronic renal failure, mental disorder and cancer. cOnclusiOns: Results found in this study are similar to those observed in other countries. Our findings show in particular that chronic diseases significantly drive health care expenditures. Using secondary data allows to classify chronic diseases according to the financial weights while controlling for characteristics of the analysed population. Results highlight the high financial burden of chronic diseases for public health care expenditures and allow decision-makers to take appropriate public health measures. PHP143 tHe effect of cHIna's basIc meDIcal Insurance scHemes on HealtH servIce utIlIzatIonObjectives: Over the past decade increasing numbers of expensive drugs have entered the market, placing a financial burden on hospitals in particular. Many high-cost therapies require use or at least initiation in the hospital setting. Many European countries reimburse hospitals via diagnosis-related group (DRG) systems. However, DRG systems are often insufficient to cover the costs of expensive drugs. Here we assess how expensive drugs are funded in hospitals across markets, what the requirements are, and the process of additional funds being granted. MethOds: Publicly available documents, governmental guidelines and regulations were assessed to understand the different processes and requirements expensive drugs need to meet to receive additional funding. Countries included were the UK, Portugal. Results: In all included countries, hospital treatments are reimbursed via DRG systems, and most provide additional funding for expensiv...

Conceptualisation and Role of Market Access in Pharmaceutical Industry: A Scoping Review

“…Within the research literature, Sendyona and colleagues [ 10 , 11 , 12 ] defined MA as the process that guarantees the development and commercial availability of pharmaceutical products with appropriate value propositions, resulting in their prescription and successful uptake decisions by payers and patients with the ultimate goal of achieving profitability and the best patient outcomes. Still, these authors concluded that “the concept of MA is still poorly understood, and the definition varies depending on the stakeholders’ perspectives” [ 12 ].…”