Pricing and Reimbursement

Faster regulatory approval has not necessarily achieved faster patient access. A new OHE paper sets out how risk-sharing can tackle this, enabling resolution of differences of view between innovators and payers about a technology’s value. The authors find risk-sharing makes sense in 9 out of 16 scenarios, setting out the conditions in which both parties should use them. Innovators need to fund the research in order to align incentives.

As US policymakers consider the potential implications of the drug pricing reforms contained within the Build Back Better Act, OHE releases a critique of the Congressional Budget Office scoring, demonstrating that the estimates are highly uncertain and policymakers should exercise caution when relying upon them.

OHE publishes a research report sponsored by CRUK on the practical considerations for outcome-based payment in the NHS

Our second blog in the OHE H.R. 3 Series discusses how the Congressional Budget Office (CBO)’s analysis of H.R.3 does not reflect the reality of biopharmaceutical investing.

US policy makers are discussing an attempt to lower prescription drug spending in the US.

In a recently published report, we explore the financial sustainability of gene therapies and highlight the factors that are likely to influence the financial sustainability of this important medical technology.

This blog discusses the rationale behind a COVID-19 patent waiver decision and contributes to the current debate by producing a balanced view on the benefits and drawbacks resulting from an intellectual property (IP) waiver, in the short- and the long run. Moreover, it offers recommendations and alternatives for expediting global access to COVID-19 vaccines without waiving their IP rights.

In this blog, we reflect on some of the key learnings from the recent pull and push strategies to develop COVID-19 vaccines in the UK, the US, and the European Union. We use our recent work on portfolio management, pricing, and procurement of COVID-19 vaccines (forthcoming as an OHE report) to organise the review.

In the contentious debate around US drug prices, less well understood is: if the price of a drug is a fair, value-based, price, how we assess if insurance coverage provides patients with ‘fair access’ to that drug? This paper from ICER and OHE authors seeks to define fair access. It proposes Ethical Goals for Access and Fair Design Criteria for cost-sharing and prior authorisation protocols.

A new Editorial reviews three solutions to the price and value challenge to reimbursing combination products. Higher thresholds are not justifiable. Evidence to support use of shorter regimens will take time to develop. Multi-use pricing is the best option to explore.

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