ABSTRACT
In patient specialty drugs will face a somewhat different payer environment than an outpatient oral diabetes drug. To simplify the classification of payers we can create several characteristic archetypes that show fundamental differences in payer approaches. Examples of a national payer archetype can be: “All decisions are driven by cost-effectiveness evidence” versus other payer management principles or “Specialty drugs are budgeted and distributed through hospital channels” versus through regular retail pharmacy channels. At a macro level, the global payer environment is characterized through several main payer management principles or archetypes that are used to manage market access and price for drugs. Obtaining access for pharmacy benefits is subject to negotiations. US Managed Care organizations and PBMs maintain drug formularies for pharmaceutical benefits, placement on which can be subject to an agreed-upon discount or rebate. Therapeutic Referencing is used as a price control principle in the great majority of healthcare systems with universal healthcare coverage.
