Financial Based Risk Sharing Agreements

The value of health care can be defined, in its simplest form, as health outcomes per dollar spent on medical care [1]. The idea of value focuses not only on the idea of profitability, but also on the idea of „bang around the goat“. The explosion of the U.S. health care system in terms of spending on prescription drugs is a growing necessity for: (1) The share of spending on prescription drugs in overall health has tripled since the 1980s and (2) Spending on prescription drugs is expected to increase rapidly by 6.7% per year by 2025 [2]. Policy makers in the health sector, including payers, suppliers and patients (significant sharing of drug costs in the United States), have emphasized an understanding of the importance of making decisions, managing pharmaceutical spending and improving care [3]. Ando G, Izmirlieva M, Honore AC. Global trends in pharmaceutical risk sharing in 2011 and 2012: slowing down? Health value. 2012; 15 (7):A322-3. Before entering into risk-sharing agreements, manufacturers need to understand the issues and implications, writes Kimberly E. White. In 2010, Carlson et al. conducted a systematic review of performance or health reimbursement systems that implemented non-results-based and health-related reimbursement systems [14].

The objective of this review is to focus solely on health outcome-based systems, since the basis of this agreement between the manufacturer and the payer is based on those in which the price, level or type of reimbursement are linked to future clinical or intermediate performance indicators that are ultimately related to the quality/quantity of patients` lives [14]. While RSA carries risks, it also creates opportunities for manufacturers. One of the greatest opportunities is the ability to develop a deeper relationship with a supplier. Through discussions, manufacturers have the opportunity to gain insight into the supplier`s processes and objectives and to create greater direction. This knowledge can lead to a stronger working relationship, which will be useful in the future. Walker S, Sculpher M, Claxton K, Palmer S. Coverage with evidence, only in research, risk sharing or patient access patterns? A framework for hedging decisions. Health value. 2012;15(3):570–9. Our results for Spain appear to be consistent with the results of some studies that have recently established that paying bodies in the health sector consider price-volume agreements to be the most common type of contract (77% have experienced these contracts, as Dunlop also found [32]); Less than half of them had experience with performance contracts – in their text „innovative agreements“ – Oncology was also the area where these contracts are applied more often, as we found in our study; the majority of respondents expressed a positive opinion on the potential of this type of agreement to enhance security, manage households and provide additional knowledge about the value of drugs. The Nazareth study [34] (which includes only one Spanish participant) also highlighted the increasing evolution of the use of these contracts in the five largest EU countries, pointing out that 60% of all contracts signed in the last 20 years were cancer drugs, mainly motivated by their increasing cost per patient. Respondents also cited the lack of a clear framework for the design, implementation and follow-up of these contracts as a drawback.

This study also predicts a significant increase in the number of these types of contracts over the next five years (according to the Spanish survey). As a research topic, it will be interesting to expand the scope of research to other countries and to check whether this knowledge is present in other jurisdictions. Results-based risk agreements include the definition of a results metric target that must be achieved before additional payments are made or a discount is offered. Merck and CIGNA, for example, agreed to link Januvi`s price