Experience of the Implementation of a Payment for Performance Based on a Risk Sharing Agreement Scheme in Argentina: Ribociclib in HR+/HER2- Advanced or Metastatic Breast Cancer Patients

Problem Statement: Payment for Performance based on a risk sharing agreements (PBRSAs) are tools that improve access to innovative drugs, especially when there is uncertainty. They link the price of a treatment to the results obtained in clinical practice.

Due to the clinical uncertanty observed with ribociclib in the treatment of patients with HR+ and HER2- advanced or metastatic breast cancer, an PBRSA was implemented.

Description: Based on the published evidence, the eligibility criteria and the thresholds for reimbursement were defined. The End Points used to define reimbursement was Progression Free Survival.

Follow-up meetings with all the parties involved were realized every three months.

Based on the RWD, the Pharmaceutical Company reimbursed the money of the units administered to the patients who progressed, presented toxicity or died before exceeding the defined thresholds.

The 46 patients who received ribociclib in combination with a non steroidal aromatase inhibitor or fulvestrant during the first year of PBRSA implementation were included in the analysis.

At month 12, 6 out of the 46 patients were regarded as treatment failures (3 disease progression, 2 deaths and 1 withdrawals due to toxicity), Direct costs of ribociclib using a traditional payment scheme plus an PBRSA compared to the traditional purchase-only scenario were 7.94% lower.

Lessons Learned: This work demonstrated that it is feasible to implement an PBRSA in Argentina, being essential for its realization a strategic association between the stakeholders involved.

Stakeholder perspective: For the implementation of the PBRSA we taken into account the perspective of the different Stakeholders: prepaid medical plans, Pharmaceutical Company, Pharmaceutical Benefit Management and audit team.