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Paying for Cures: Perspectives on Solutions to the "Affordability Issue"
Sarah Karlsberg Schaffer1, Donna Messner2, Jorge Mestre-Ferrandiz1
1Office of Health Economics, London, UK.
Summary
Innovative medicines offer significant health gains but pose affordability challenges. Payers are skeptical of novel payment solutions, preferring traditional methods like price negotiation and access restrictions.
Area of Science:
- Health Economics
- Pharmaceutical Policy
Background:
- Game-changing therapies present significant health gains but also affordability challenges for healthcare systems.
- These challenges are amplified by uncertain long-term effectiveness and value for money.
Purpose of the Study:
- To review innovative payment solutions for drug affordability.
- To assess the feasibility and desirability of these solutions through discussions with payers.
Main Methods:
- Literature review of innovative payment solutions.
- Semistructured interviews with payers in the United States and Europe.
Main Results:
- A mismatch exists between academic enthusiasm for new payment models and payer skepticism.
- Payers expressed interest in outcomes-based payments but cited operational costs and implementation challenges.
- Traditional methods like price bargaining, co-pays, and restricted access remain prevalent.
Conclusions:
- Innovative payment solutions face significant hurdles to adoption by payers.
- Outcomes-based payments, while conceptually appealing, are not currently attractive for managing affordability.
- Affordability pressures will likely continue to be managed through existing, albeit restrictive, mechanisms.