The emergence of high-price innovative therapies is exerting strong financial pressure on healthcare payers worldwide. Most of the recently approved advanced therapy medicinal products are for oncology indications, often in rare and ultra-rare populations. Given the high per-patient prices, which can exceed one million Euros, payers’ ability to absorb multiple gene therapies while delivering affordable access to healthcare is questionable.
The coronavirus disease 2019 pandemic has highlighted advantages and limitations of different current mechanisms for funding research, development, manufacturing, and distribution of biomedical innovation. Traditionally transparency about research and development costs is lacking, as manufacturers rarely make public the costs incurred in product development, as part of the pricing and reimbursement negotiation. Similarly, in 2019 a world-first subscription payment model was launched in the UK to incentivise pharmaceutical companies to develop new drugs for resistant infections. The idea behind this scheme involves decoupling payment from the volume sold and, instead, rewarding pharmaceutical companies for the development of novel antibiotics with regular payments based on their overall value to society.
In addition, system access and affordability issues exist for future Alzheimer’s disease treatments. Because the target population is potentially very large, even cost-effective treatments may be unaffordable given skyrocketing budget impact.
This array of contemporary issues facing third-party payers worldwide illustrates how a single payment model is not going to provide an effective answer in every situation, but rather innovative pricing and payment models need to be considered and developed to ensure financial sustainability of both public and private health care systems, adequate incentives for innovation, and fast access for high-cost innovative medicines.
Therefore, the overall objectives of the Health Innovation Next Generation Pricing Models (HI – PRIX) project are:
1. to extensively map and formulate new pricing and payment schemes that can be used across technology classes, therapeutic areas, setting and healthcare systems/geographies together with a related set of principles that may guide successful adjustment and flexible implementation to the particular context of use;
2. to investigate the impact on competitiveness, innovation, equity and affordability of a pipeline of contracting modalities for health innovations to move from regulatory approval through value assessment to adoption;
3. to address the challenges and concerns of payer, manufacturer, healthcare professional, and patient perspectives regarding different models of pricing by sustaining an effective dialogue across stakeholders’ groups about the trade-offs between affordability, innovation and patient access.
