Implementation of risk-sharing contracts as perceived by Spanish hospital pharmacists

Abstract

BackgroundConcerns about financial sustainability of health systems have promoted the adoption of risk-sharing agreements. Nevertheless, few insights have been derived, due to their confidentiality. The purpose of this study is to analyze to what extent these agreements have been implemented in Spain and the importance of several clinical and management variables concerning their use. We also explore whether risk-sharing agreements promote the adoption of personalized medicine. We give a descriptive analysis based on a questionnaire sent to members of the Spanish Society of Hospital Pharmacy, asking about the implementation of risk-sharing contracts in their hospitals.ResultsThere were 80 replies. Implementation of risk-sharing agreements was high (90%), being oncology, neurology, dermatology and infectious diseases the main specialties. The most relevant variables were the number of units of medication per year (89%) in price-volume agreements, and the efficacy and uncertainty of treatments (over 75%) in pay-for-performance agreements. Price-volume agreements were suitable for both conventional and personalized medicine and pay-for-performance more specific for personalized medicine. Paying for performance promotes genetic testing (85%).ConclusionsThe results suggest health authorities should encourage the assessment of financial and health outcomes of real-world contracts of conventional and personalized medicine to better know the variables influencing their use.

Barriers and Opportunities for Implementation of Outcome-Based Spread Payments for High-Cost, One-Shot Curative Therapies

“…Maes et al propose two possible solutions to comply with the ESA: the payer pays for the service of the treatment delivering long-term health outcomes or the payer pays for data services as a delivered data package per year instead of paying for a single treatment administration ( Maes et al, 2019 ). Furthermore, healthcare systems wishing to implement spread payments may face national legal barriers which may require adjustment of country-specific regulations ( Carlson et al, 2009 ; Carlson et al, 2011 ; Espin et al, 2011 ; Ferrario and Kanavos, 2013 ; Tuna et al, 2014 ; Kleinke and McGee, 2015 ; Barlas, 2016b ; Proach et al, 2016 ; Montazerhodjat et al, 2016 ; Kanavos et al, 2017 ; Nazareth et al, 2017 ; NEHI, 2017 ; PWC Health Research Institute, 2017 ; Spark et al, 2017 ; Goncalves et al, 2018 ; Salzman et al, 2018 ; Infante et al, 2019 ; Lorente et al, 2019 ; Mahendraratnam et al, 2019 ). For instance, the current legislation in Spain only allows long-term spending for certain investments which excludes medicines and Sweden does not allow payments for more than three years for non-investment consumables (that are not purchased to deliver financial return) ( Alliance for Regenerative Medicine, 2019 ).…”

“…However, these costs can be highly variable since the MS risk-sharing scheme in the United Kingdom was estimated to cost nearly £50 million annually ( Sudlow and Counsell, 2003 ; Raftery, 2010 ) while the costs of the OBA for gefitinib in Catalonia were estimated to be negligible due to the readiness of the organisational structures ( Clopes et al, 2017 ). The majority of costs are attributed to the increase in personnel time and required personnel to perform data collection, the cost of the infrastructure required for data collection, guaranteeing compliance with the established agreement and initiating payments ( Sudlow and Counsell, 2003 ; Raftery, 2010 ; Loveman et al, 2011 ; Garrison Jr et al, 2013 ; Garattini et al, 2015 ; Garrison Jr et al, 2015 ; Clopes et al, 2017 ; Jorgensen and Kefalas, 2017 ; Macaulay and Hettle, 2017 ; Kefalas et al, 2018 ; Mailankody and Bach, 2018 ; FoCUS, 2019a ; Lorente et al, 2019 ; Mundy et al, 2019 ). This burden is predominantly experienced by the payer and the healthcare professionals who are responsible for overseeing the agreement and performing data collection.…”

Payer perceptions of the use of real-world evidence in oncology-based decision making

“…A growing body of evidence suggests the use of outcomes-based contracts is expanding and should continue to be evaluated for their value. 6,23,24 While interest in outcomes-based contracting is high, confidence in how to operationalize such contracts is still nascent. Therefore, payers and manufacturers have an opportunity to work together to refine measurable definitions of endpoints and outcomes, value measures, and other variables with an eye towards defining best practices.…”

Analysis of Market Access Agreements in Turkey

“…Depending on the type of agreement, pharmaceutical companies either offer discounts on sales volume (price-volume agreements) or apply total or partial reimbursements when treatments are not as effective and safe as initially believed (payment agreements for performance) [25].…”