Nov-15: Healthcare Similarities & Differences

Nov-15: Healthcare Similarities & Differences

As I prepare to leave the United States (US) for the ISPOR meeting in Milan, I began to think about differences in healthcare systems.

Many countries in Europe use the Euro, a common currency. Despite this similarity, these countries have different health systems, approval processes, and reimbursement rates. Products on the market in one country might not have made it to market in a neighboring country. Products available in several countries might have vastly different pricing, reimbursement, and even names.

Products marketed in the US are approved through a single agency, the Food and Drug Administration (FDA). However, different payors govern product use and reimbursement for their members and covered lives. There are major differences in insurers and payors throughout the US. The Medicare system (a national program for the old and "special" populations) has a constant set of rules, but adjusts for regional differences and provides extra reimbursement for teaching and other special circumstances. While Medicaid is a national program for the poor, each state defines their own Medicaid benefit with the federal government matching their payments. Commercial plans are also regulated by state insurance boards and people who live in a multi-state region often find the insurer in one state doesn't cover their neighboring state. Some commercial plans operate nationally, others are regional. Coverage can differ for competing plans and products-the preferred agent for one plan might be restricted for another plan in the same area.

These differences show up in a variety of areas. Recently, it's been highlighted in several presentations on the developing US biosimilar market. While these products may be similar, the rules, regulations, availability and product names differ from country to country.

The JeSTARx team has been busy participating in industry meetings. Our work with our partner company the NPRT (National Payor Roundtable) to understand the US payor market's handling of specialty pharmaceuticals was recognized as the third best poster at the recent National Association of Specialty Pharmacy (NASP) meeting. We will be presenting several posters in Milan next week during the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) meeting (Nov 7-11) and look forward to seeing you.

We know that sometimes your data and research needs can't wait. We are here to help. Please give me a call (office 973-208-8621) or email me at to discuss.

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