Introduction
European public healthcare systems are facing increasing budget pressure, driven by post-pandemic fiscal constraints, inflation, multimorbidity and the growing number and cost of innovative therapies.
As payers increasingly rely on cost-containment measures to manage affordability, therapies with high-budget impact, large eligible populations or uncertainty around clinical and economic value may face greater reimbursement friction. However, the extent and nature of reimbursement friction varies substantially by therapy area and market. Across Europe, this can range from restricted eligibility and negative reimbursement decisions to statutory exclusions.
Obesity medicines illustrate the tension between evidence uncertainty, budget impact and high patient demand. As a result, restricted or phased public access to GLP-1/GIP therapies has coincided with substantial growth in private and self-pay channels. This raises the question of whether similar dynamics exist in other therapy areas: could privately funded care provide an alternative or complementary access route where public reimbursement is particularly challenging?
Authors: Nick Yiannouka, BSc; Higia Vassoler, BSc, MSc; Josh Grewal, BSc, MSci
Objectives
- Identify and rank therapy areas experiencing the greatest public reimbursement friction across European markets
- Assess the role of private-market patient access among high-friction therapy areas as an alternative or
complementary access route
Conclusions
- Public reimbursement friction across Europe was most often characterised by restricted eligibility, leading to heterogeneous levels of access across countries
- Private-market as an alternative access route was strongest for obesity / weight management, erectile dysfunction and fertility / ART, where demand aligned with simpler or service-led delivery
- In contrast, Alzheimer disease-modifying therapies and gene therapies / ATMPs remained poorly suited to broad private access, as high costs, specialist infrastructure and monitoring requirements represent significant barriers for current funding models
- Overall, private funding as an alternative access route appears most feasible in therapy modalities with self-pay channels and non-specialist delivery models