Payment Models for Multi-Indication Therapies

Cole, A., Neri, M. and Cookson, G.

Consulting Report
November 2021

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For the growing number of multi-indication medicines, access may be delayed or even denied due to challenges in linking payment with a medicine’s value across those indications. We assembled a broad range of stakeholders to work toward consensus on the challenges and solutions which promote better patient access and sustainable health care and innovation.

The main objectives of pricing that are not well addressed by inflexible uniform prices are: optimising incentives for innovation and optimising access for patients. The expert panel considered that differentiating payment based on value at the indication-level represents an important part of the solution for multi-indication therapies, for which implementation must recognise divergent country health systems and experience.

Value recognition at indication-level can be achieved in multiple ways, including blended pricing (with actual/estimated usage), single price with differential adjustments, and outcome-based payments. The evolution of medical innovation and the need for sustainable financing requires health systems to adapt their payment models in ways that value clinical benefits in ever-smaller and multiple patient groups. Data systems must be utilised and evolve to accommodate this need, in order to realise full benefits of medical innovation for patients and health systems.

See here for the report appendices.