Key takeaways

  • Combination therapies (CTs) can provide effective treatment options and improve patient outcomes, but the lack of accepted pricing models in Europe represents a barrier to their access.
  • Drawing learnings from multi-indication pricing, we propose the adoption of strategies that support combination-based differential pricing (CBDP).
  • We outline a framework for identifying suitable pricing models, grounded in the clear specification of the CT being considered in terms of therapy configuration, developer configuration, and other factors.
  • Stakeholders should pursue CBDP and, specifically, value-aligned combination pricing, whereby differential prices or payments are agreed according to the value generated by the treatments in different uses.
  • By adopting this framework, stakeholders can ensure that CTs are priced in a manner that reflects their value to patients and the health care system, while encouraging new innovations in the CT space.

This report introduces a framework to support the identification of suitable pricing models for combination therapies, addressing the complex challenges faced in bringing cost-effective combinations to market. With the development of combination therapies becoming more common in oncology and beyond, and a lack of agreed-upon pricing models in Europe, the need for innovative pricing strategies is increasingly evident. The challenges associated with access to combination therapies are well understood and include issues relating to affordability, value attribution, legal constraints, and availability of evidence.

We develop scenarios that should be used to classify combination therapies as a basis for identifying the most suitable pricing model. Therapies may be classified according to scenarios relating to the therapy configuration, developer configuration, patent status, and therapy uses. This classification of combination therapies serves as the foundation for the approach that we outline, supporting tailored pricing strategies that reflect specific circumstances and constraints.

The report draws learnings from the literature on multi-indication pricing, which is analogous to the case of combination therapies. Proposed pricing models in this context include those based on net price adjustments to list prices, weighted or ‘blended’ prices, multiple prices for the same therapies, and outcome-based payments. We consider the suitability of these models for combination therapies and introduce the notion of ‘combination-based differential pricing’ (CBDP). This concept allows for flexibility in the adoption of any specific pricing or payment model that supports differential pricing for combination therapies. Models of CBDP allow for different mechanisms through which prices can be differentiated. In principle, these adjustments can be made based on either volume or value and may be specified ex-ante or ex-post.

We outline a strategic approach for decision-makers to implement CBDP effectively by precisely specifying the scenario for a given combination therapy. This enables stakeholders to navigate the challenges and barriers that we discuss and select the most suitable pricing model. Decision-makers should adopt our proposed approach and use it as a foundation to:

  • Implement combination-based differential pricing,
  • Pursue value-aligned combination pricing, and
  • Consider volume-aligned combination pricing as an interim solution where necessary.

In many cases, net price adjustments should be the preferred strategy. Where evidence of value is lacking, and concerns about affordability dominate, volume-aligned combination pricing may be a viable interim solution while a system to support value-aligned pricing is developed. CBDP is just one part of a wider strategy to support access to combination therapies, and important barriers and facilitators must be considered when selecting a pricing model.

By adopting this framework, stakeholders can ensure that combination therapies are priced in a manner that reflects their value to patients and the healthcare system. This will support progress towards a system where patient access to clinically effective combination therapies is timely and affordable.