Slide Snapshot: Payer Archetypes in Europe

By Dr Nick Proctor and Megan O'Brien, expert trainers of the Understanding Pharma Market Access & Payers in Europe course

The European healthcare landscape is fragmented and complex. This free slide snapshot gives you a practical framework for categorising payers based on shared characteristics, so you can plan smarter access strategies.

Different dimensions, different strategic uses

The slide snapshot explains three ways to archetype payers, each designed for a specific planning purpose.
 

1. Health system structure: National, multi-tiered or decentralised?

Who has the final say? 

• National markets

  Healthcare costs are controlled through national pricing and reimbursement submissions, negotiations and decisions. No other major availability hurdle. National payers exert limited economic influence on individual clinical behaviour.

• Multi-tiered markets

  National pricing and reimbursement decisions exist, but regions are responsible for managing the healthcare budget. Regions may seek to influence clinical behaviour by limiting formulary inclusion and hence availability.

• Decentralised markets

  National bodies exercise limited power in restricting availability. Regional and local bodies use financial incentives to influence clinical behaviour.

💡 Useful for: global launch expenditure planning, planning field force headcount, marketing collateral planning, uptake forecast planning, designing a research sample.
 

2. Position in health system: National, regional, local or patient?

Decision-making is sequential, so not all payers carry equal weight.

• National

  Sets overall rules or recommendations for reimbursed access. Requires data proving a product is comparatively or cost-effective. Can handle very sophisticated data and models. Interaction is typically via formal submission package with strict guidelines. Often a two-part value and price assessment process.

• Regional

  In several countries with decentralisation, regional payers are more important. Can provide treatment guidelines or go as far as developing regional formularies where healthcare spending is devolved. Some handle sophisticated data in formal submissions; some group together to review new drugs; some allow informal dialogue and negotiation.

• Local / hospital

  Formulary committee members alongside their functions as clinicians, pharmacists and administrators. They tend to be less used to sophisticated data; interaction is likely to be less formal.

• Patient

  In the major five EU markets the patient is not a key payer. However, in a broader context they can be responsible for significant cost-share or full out-of-pocket payment of drug costs.

💡 Useful for: account management of maturing brands, regional and country-level marketing, planning field force onboarding and training, tailoring research materials, uptake forecast planning.
 

3. Payer evaluation methods: How does this payer make pricing, reimbursement and access decisions?

How a payer makes pricing, reimbursement, funding and access decisions determines what evidence you need to gather during clinical development and evidence generation.

• Cost effectiveness: Decisions are made on the basis of formal cost-effectiveness analysis.
• Comparative clinical effectiveness: Decisions are made on the basis of formal analysis of comparative clinical effectiveness.
• Budget optimisation: Decisions are strongly influenced by budget impact and cost control.
• Competitive rationalising free market: Decisions are strongly influenced by market forces and supply chain profitability.
• Patient: The patient pays some or all drug costs out of pocket. The purchasing or fulfilment decision is based on affordability, perceived therapeutic benefit and similar factors.

💡 Useful for: global launch evidence planning, global submission planning, global pricing planning, tailoring research materials.
 

Expert content from Access Infinity and CELforPharma

This slide snapshot was created by Dr Nick Proctor and Megan O’Brien, faculty members and expert trainers for the Understanding Pharma Market Access & Payers in Europe course at CELforPharma, in collaboration with Access Infinity. It is a free excerpt from that course, designed for market access, medical affairs, marketing and business development professionals working across European markets.
 

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