International Differences in the Role of Payer and Administrative Controls in Prescribing Decisions.

Presented at ISPOR 18th Annual European Congress, Milan, 7th – 11th November 2015, Milan UPDATE ● The major 5 European markets all operate socialised healthcare systems. In each there are different structures and organisations in place to assess the value of medical interventions, and a number of different decision makers who act on the basis of these assessments to ensure efficient use of healthcare resources. Collectively these decision makers are commonly referred to as payers. ● One of the key objectives of the payer is to influence prescribing behaviour, to ensure effective use of healthcare resources in order to contain healthcare costs while simultaneously allowing an acceptable minimum quality of care. To achieve this they use a number of administrative approaches. These vary according to the care setting. ● Less clear is the extent to which these administrative controls are effective tools to influence prescribing behaviour; the extent to which prescribers feel that these are implemented appropriately or how this varies between countries or therapy areas. ● Oncology is an interesting setting in which to explore this topic for two key reasons: There is a mix of locally active payers (located within the organisations where care is given), national decision makers and in some cases regional or quasi regional payers who are further removed from the prescriber. It is a highly emotive therapy area, in which innovative drugs are often costly – providing the possibility for tension between the payers’ incentive to attempt to contain use of new medications, and the prescribers’ desires to use new treatments to improve outcomes in terminal conditions. ● The objective of the analysis was to assess the extent to which prescribing decisions are influenced by payer implemented controls.