Environmental Aspects in Price and Reimbursement Decisions of Medicines-A Scoping Review

Environmental impacts of medicines are increasingly recognised but rarely embedded in their pricing and reimbursement (P&R) and related assessments. This scoping review mapped how environmental aspects, including antimicrobial resistance (AMR) stewardship, are or could be considered in P&R of medicines and identified challenges for their implementation. Electronic searches from PubMed, Scopus, Web of Science, Edilex, HeinOnline, Westlaw, Google Scholar and official agencies' websites were conducted. Eligible items covered developed country settings and described existing or proposed integration of environmental aspects into medicine pricing or reimbursement. Of 4476 publications, 21 were included. The publications were from 2013 to 2023, most of them addressing ecotoxicological and climate impacts. Six types of means to embed environmental aspects into P&R were identified: health technology assessment (HTA) integration, reimbursement criteria, pricing criteria, environmental classification, regulation and delinkage models. Most proposals were conceptual, whereas implemented or piloted examples focused on AMR-oriented means. Reported challenges for implementation included challenges regarding data availability, comparability and verification; valuation and methodological integration; incentive design and cost distribution; and equity and political feasibility. Environmental aspects are not yet routine in medicine P&R assessments due to a lack of standardised, verifiable product-level data, appraisal methods and equity-sensitive policy design.