Launching in the US healthcare market

Discover key facts about the healthcare market in the USA and learn about our latest market research for our pharmaceutical, medical device and healthcare sector clients.

Key facts about the US health market:

Funding in the US healthcare system

The US healthcare system does not provide universal coverage and can be defined as a mixed system. Publicly financed programs such as Medicare, Medicaid, Children’s Health Insurance Program (CHIP), and military programs co-exist with commercial healthcare insurance. This complex system is financed by a mixture of public payers (federal, state, and local government), as well as through private insurance premiums paid by individuals or their employers and individual payments.

Health technology assessment in the USA

In contrast to many developed countries, the US does not have a national HTA program to broadly evaluate medicines or medical devices and guide coverage and pricing decisions. While US payers frequently use internal processes that incorporate elements of HTA to inform their coverage decisions, these processes lack transparency and involve duplicated efforts across organisations.

In the absence of a governmental HTA body, the Institute for Clinical and Economic Review (ICER) has emerged to evaluate drugs, devices, and diagnostics. When making coverage decisions, the decisions of some payers may be influenced by ICER assessments, though these are non-binding recommendations only.

Why work with a European-based market access consultancy?

If the US is your first launch market, you may be wondering about the benefits of working with a European-based consultancy over a local agency.

First and foremost, we are a Global Market Access agency. Whilst the majority of our team are based in the UK, we deliver projects to Global clients around the world. As such, we understand the needs and processes of major launch markets and archetypes, and how to factor these into a cohesive Global market access strategy.

Our work takes a broader perspective than the first launch market. This is particularly important for the US market, a setting that is quite different from many other major launch markets. We use our understanding of all market archetypes to deliver a suitable strategy for the US, Europe, Asia, and beyond.

We collaborate with our affiliates across the world to ensure our strategic and tactical deliverables resonate with key stakeholders, such as payers, clinicians, and policy makers. This ensures that local adaptations of Global materials, which are developed with affiliates in mind, are efficient and meet the needs of different markets.

In practice, the time difference means that we can deliver materials for you to review at the start of your day. We are flexible with our working hours, allowing us to make time for meetings throughout your working day.