Presentation (CTI)

OBJECTIVES: Accessing new medicines through public payers in Europe is becoming more challenging due to rising demand and budget constraints. As a result, manufacturers are increasingly exploring alternative routes such as private health insurance (PHI) and out-of-pocket (OOP) payments. This research assessed the role of PHI and OOP access across five major European markets.
METHODS: The study combined interviews with five private payer experts and desk research to evaluate market size, coverage, and trends in France, Italy, the UK, Germany, and Spain.
RESULTS: In France, supplementary insurance is universal and mandatory, with ~80% covered by mutual schemes and ~20% by PHIs. These primarily cover co-payments rather than non-reimbursed drugs. In Italy, ~10% of the population has PHI, often employer-based, but it rarely includes pharmaceuticals. OOP spending is significant, accounting for ~25% of total drug expenditure, particularly for non-reimbursed prescription medicines (Class C). In the UK, 22% of the population is covered by PHI (£11.4bn market in 2022). Coverage focuses on inpatient care, including hospital-administered medicines aligned with NICE guidance. Outpatient drugs are typically excluded, though some oncology policies provide access beyond NICE recommendations. In Germany, ~10% of the population holds substitutive private insurance (PKV). While coverage largely mirrors statutory insurance (GKV), prescribing is based on medical need rather than cost controls, potentially increasing use of higher-cost therapies. In Spain, 26% of the population has PHI (12.6 million people). Insurance is supplementary and mainly provides faster access, greater choice, and private care, rather than expanded pharmaceutical coverage.
CONCLUSIONS: The role of PHI and OOP can vary substantially between markets. Manufacturers seeking non-public access routes must adopt highly tailored, country-specific strategies.