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.

Isn’t Mtech Access a European-based market access consultancy?

No, now that we are powered by Petauri we are truly Global with many US-based colleagues. This includes an in-house team of former US access decision-makers, with experience across all lines of business, including Medicare, Medicaid, and Commercial. Petauri also have a broader network of >100 current US payers and advisers. We work closely with these colleagues and can tap into this network to support all are US projects.