Reimbursement Pathways for New Diabetes Technologies in Europe: Top-Down Versus Bottom-Up.

Reimbursement by payers (policy makers and budget holders) is critical for the uptake and use of new diabetes technologies. The purpose of this article is to describe the different reimbursement pathways that exist for new diabetes technologies in five selected European countries using examples of recent reimbursement decisions. Countries can be grouped into one of three categories: "top-down" (where reimbursement decisions are usually made by policy makers, eg, France), "bottom-up" (where reimbursement decisions are usually made by budget holders, eg, Italy and Spain) and "mixed" (where reimbursement decisions can be made by both policy makers and budget holders, eg, Germany and England). Whatever category a specific country falls into will have different implications from a market access perspective.