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.

To discuss your US launch strategy with our experts or to enquire about market research services, get in touch using the form below.

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    The role of economic evaluation in US healthcare

    The role of economic evaluation in US healthcare

    Hannah Palin (Director – Market Access) and Calum Jones (Associate Director – Health Economics) explore the landscape for economic evaluation in the US and highlight important considerations for companies seeking to infiltrate this key market.

    What role does ICER play in US market access? cover

    What role does ICER play in US market access?

    We delve into ICER’s influence on drug pricing and access in the US. We also explore the importance of maximising engagement with ICER for favourable pricing and access outcomes.

    AMCP dossier planning for US market access and reimbursement cover

    AMCP dossier planning for US market access and reimbursement

    What is an Academy of Managed Care Pharmacy (AMCP) dossier and how are they used in US market access? Drawing on their extensive experience compiling AMCP dossiers, here, our global market access experts explain when, why, and how AMCP dossiers are used, how they are formatted for formulary submissions, and how AMCP dossiers compare with global value dossiers.