A drug can be approved and still be out of reach if no one pays for it. Reimbursement is the process by which insurers, governments, or employers pay for medications. In many countries, a national health system negotiates prices and decides which drugs are covered. In others, private insurers manage formularies and copays. The result is a patchwork of coverage that varies widely by country, plan, and drug.

Reimbursement decisions consider cost, efficacy, and budget impact. Health technology assessment bodies, such as NICE in the UK and ICER in the US, evaluate whether a drug provides good value for the money. They compare the drug to existing treatments and calculate cost-effectiveness ratios. A drug that is effective but very expensive may be restricted to certain patients or not covered at all. Manufacturers negotiate with payers, sometimes offering discounts or outcomes-based contracts. Patients may face copays, deductibles, or coinsurance, which can affect adherence.

Key concepts:

• Coverage. Whether a drug is included in a plan.
• Copay. The fixed amount a patient pays per prescription.
• Coinsurance. A percentage of the drug cost paid by the patient.
• Formulary tier. The cost-sharing level assigned to a drug.
• Prior authorization. Approval required before coverage.

Reimbursement is one of the main levers for controlling drug spending. It also shapes which drugs patients can actually access.