Stratified Medicine and Reimbursement Issues

• Main Authors: Hans-Joerg eFugel, Mark eNuijten, Maarten ePostma
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2012-10-01
• Series: Frontiers in Pharmacology
• Subjects: Biomarkers, Pharmacological; diagnostics; reimbursement; Stratified Medicine; Health Technology Assessment
• Online Access: http://journal.frontiersin.org/Journal/10.3389/fphar.2012.00181/full

Stratified Medicine (SM) has the potential to target patient populations who will most benefit from a therapy while reducing unnecessary health interventions associated with side effects. The link between clinical biomarkers/diagnostics and therapies provides new opportunities for value creation to strengthen the value proposition to pricing and reimbursement (P&R) authorities. However, the introduction of SM challenges current reimbursement schemes in many EU countries and the US as different P&R policies have been adopted for drugs and diagnostics. Also, there is a lack of a consistent process for value assessment of more complex diagnostics in these markets. New, innovative approaches and more flexible P&R systems are needed to reflect the added value of diagnostic tests and to stimulate investments in new technologies. Yet, the framework for access of diagnostic–based therapies still requires further development while setting the right incentives and appropriate align stakeholders interests when realizing long- term patient benefits. This article addresses the reimbursement challenges of SM approaches in several EU countries and the US outlining some options to overcome existing reimbursement barriers for stratified medicine.