1
|
Rejon-Parrilla JC, Espin J, Garner S, Kniazkov S, Epstein D. Pricing and reimbursement mechanisms for advanced therapy medicinal products in 20 countries. Front Pharmacol 2023; 14:1199500. [PMID: 38089054 PMCID: PMC10715052 DOI: 10.3389/fphar.2023.1199500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/06/2023] [Indexed: 02/12/2024] Open
Abstract
Introduction: Advanced Therapy Medicinal Products are a type of therapies that, in some cases, hold great potential for patients without an effective current therapeutic approach but they also present multiple challenges to payers. While there are many theoretical papers on pricing and reimbursement (P&R) options, original empirical research is very scarce. This paper aims to provide a comprehensive international review of regulatory and P&R decisions taken for all ATMPs with centralized European marketing authorization in March 2022. Methods: A survey was distributed in July 2022 to representatives of 46 countries. Results: Responses were received from 20 countries out of 46 (43.5%). 14 countries reimbursed at least one ATMP. Six countries in this survey reimbursed no ATMPs. Conclusion: Access to ATMPs is uneven across the countries included in this study. This arises from regulatory differences, commercial decisions by marketing authorization holders, and the divergent assessment processes and criteria applied by payers. Moving towards greater equality of access will require cooperation between countries and stakeholders, for example, through the WHO Regional Office for Europe's Access to Novel Medicines Platform.
Collapse
Affiliation(s)
- Juan Carlos Rejon-Parrilla
- Health Technology Assessment Area (AETSA), Andalusian Public Foundation Progress and Health (FPS), Seville, Spain
| | - Jaime Espin
- Andalusian School of Public Health, Granada, Spain
- Instituto de Investigación Biosanitaria ibs, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Cátedra de Economía de la Salud y Dirección de Organizaciones Sanitarias (Esalud2), Granada, Spain
| | - Sarah Garner
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Stanislav Kniazkov
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - David Epstein
- Department of Applied Economics, University of Granada, Granada, Spain
| |
Collapse
|
2
|
Butani D, Faradiba D, Dabak SV, Isaranuwatchai W, Huang-Ku E, Pachanee K, Soboon B, Culyer AJ, Teerawattananon Y. Expanding access to high-cost medicines under the Universal Health Coverage scheme in Thailand: review of current practices and recommendations. J Pharm Policy Pract 2023; 16:138. [PMID: 37936171 PMCID: PMC10631213 DOI: 10.1186/s40545-023-00643-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/21/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND There has been an increasing demand to reimburse high-cost medicines, through public health insurance schemes in Thailand. METHODS A mixed method approach was employed. First, a rapid review of select high-income countries was conducted, followed by expert consultations and an in-depth review of three countries: Australia, England and Republic of Korea to understand reimbursement mechanisms of high-cost medicines. In Thailand, current pathways for reimbursing high-cost medicines reviewed, the potential opportunity cost estimated, and stakeholder consultations were conducted to identify context specific considerations. RESULTS High-income countries reviewed have implemented a variety of pathways and mechanisms for reimbursing high-cost medicines under specific eligibility criteria, listing processes, varying cost-effectiveness thresholds and special funding arrangements. In Thailand, high-cost medicines that do not offer good value-for-money are excluded from the reimbursement process. A framework for reimbursing high-cost medicines that are not cost-effective at the current willingness-to-pay threshold was proposed for Thailand. Under this framework, specific criteria are proposed to determine their eligibility for reimbursement such life-saving nature, treatment of conditions with no alternative treatment options, and affordability. CONCLUSION High-cost medicines may become eligible for reimbursement through alternative mechanisms based on specific criteria which depend on each context. The application of HTA methods and processes is important in guiding these decisions to support sustainable access to affordable healthcare in pursuit of Universal Health Coverage (UHC).
Collapse
Affiliation(s)
- Dimple Butani
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Dian Faradiba
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Saudamini Vishwanath Dabak
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand.
- Institute of Health Policy, Management and Evaluation, St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
| | - Evan Huang-Ku
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada
| | - Kumaree Pachanee
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Budsadee Soboon
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Anthony J Culyer
- Department of Economics and Related Studies and Centre for Health Economics, University of York, York, UK
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| |
Collapse
|
3
|
Farmer C, Barnish MS, Trigg LA, Hayward S, Shaw N, Crathorne L, Strong T, Groves B, Spoors J, Melendez Torres GJ. An evaluation of managed access agreements in England based on stakeholder experience. Int J Technol Assess Health Care 2023; 39:e55. [PMID: 37497570 DOI: 10.1017/s0266462323000478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVES The objective of this research was to evaluate managed access policy in England, drawing upon the expertise of a range of stakeholders involved in its implementation. METHODS Seven focus groups were conducted with payer and health technology assessment representatives, clinicians, and representatives from industry and patient/carer organizations within England. Transcripts were analyzed using framework analysis to identify stakeholders' views on the successes and challenges of managed access policy. RESULTS Stakeholders discussed the many aims of managed access within the National Health Service in England, and how competing aims had affected decision making. While stakeholders highlighted a number of priorities within eligibility criteria for managed access agreements (MAAs), stakeholders agreed that strict eligibility criteria would be challenging to implement due to the highly variable nature of innovative technologies and their indications. Participants highlighted challenges faced with implementing MAAs, including evidence generation, supporting patients during and after the end of MAAs, and agreeing and reinforcing contractual agreements with industry. CONCLUSIONS Managed access is one strategy that can be used by payers to resolve uncertainty for innovative technologies that present challenges for reimbursement and can also deliver earlier access to promising technologies for patients. However, participants cautioned that managed access is not a "silver bullet," and there is a need for greater clarity about the aims of managed access and how these should be prioritized in decision making. Discussions between key stakeholders involved in managed access identified challenges with implementing MAAs and these experiences should be used to inform future managed access policy.
Collapse
Affiliation(s)
- Caroline Farmer
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, Exeter, UK
| | - Maxwell S Barnish
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, Exeter, UK
| | - Laura A Trigg
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, Exeter, UK
| | - Samuel Hayward
- Health and Care Public Health Team, North Somerset Council
| | - Naomi Shaw
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, Exeter, UK
| | - Louise Crathorne
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, Exeter, UK
| | - Thomas Strong
- Managed Access Team, National Institute for Health and Care Excellence (NICE), London, UK
| | - Brad Groves
- Managed Access Team, National Institute for Health and Care Excellence (NICE), London, UK
| | - John Spoors
- Medicines Value and Access Unit, NHS England, London, UK
| | - G J Melendez Torres
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, Exeter, UK
| |
Collapse
|
4
|
Lee B, Bae EY, Bae S, Choi HJ, Son KB, Lee YS, Jang S, Lee TJ. How can we improve patients' access to new drugs under uncertainties? : South Korea's experience with risk sharing arrangements. BMC Health Serv Res 2021; 21:967. [PMID: 34521408 PMCID: PMC8442279 DOI: 10.1186/s12913-021-06919-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/19/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND New drugs including cancer drugs and orphan drugs are becoming increasingly more expensive. Risk sharing arrangements (RSAs) could manage the risk based on both financial impact and the health outcome of new drugs if reimbursed. To improve patients' access to new drugs under uncertainties, many developed countries have adopted RSAs. In this study, we aimed to understand the effects of RSAs in South Korea on patients' access. METHODS We reviewed current status of RSA drugs in South Korea. The number of appraisals and time gap between market approval and reimbursement per RSA drug were considered to quantify improvement of patients' access as they showed how rapidly decisions on reimbursement of RSA drugs were derived. Then, we applied a comparative analysis to determine whether the RSA drugs in South Korea were reimbursed in the UK, Italy, and Australia. Most data for this study were obtained from websites of the governmental department/agencies responsible for appraisal of drug reimbursement in each country. And literatures related to RSAs were investigated as well. RESULTS The eligibility for Korean RSAs had two key components - drugs for cancer and rare diseases and not having other alternative treatments. As of the first half of 2019, there were 39 RSA drugs reimbursed in South Korea, the majority of which were financial-based schemes. Refund and expenditure cap were the representative types (89.7%). After introduction of RSAs, the time gap and number of appraisals were decreased. Based on the indications of RSA drugs, the level of drug coverage in South Korea was found lower than Italy, similar to the UK, and higher than Australia. CONCLUSIONS RSAs in South Korea significantly enhanced patients' access to new drugs and led to the alleviation of patients' out-of-pocket expenses. The drug coverage of South Korea had a level comparable to that of other countries. This study provides implications for countries that have a dual mission of containing pharmaceutical expenditure and improving access to new drugs.
Collapse
Affiliation(s)
- Boram Lee
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Eun-Young Bae
- College of Pharmacy, Gyeongsang National University, Jinju, South Korea
| | - SeungJin Bae
- College of Pharmacy, Ewha Womans University, Seoul, South Korea
| | - Hyun-Jin Choi
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Kyung-Bok Son
- College of Pharmacy, Ewha Womans University, Seoul, South Korea
| | - Young-Sil Lee
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Suhyun Jang
- College of Pharmacy, Gachon University, Incheon, South Korea.,Institute of Pharmaceutical Sciences, Gachon University, Incheon, South Korea
| | - Tae-Jin Lee
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea. .,Institute of Health and Environment, Seoul National University, Seoul, South Korea.
| |
Collapse
|