BEYOND INCOME TIERS: AN ADAPTIVE VALUE-BASED PRICING FRAMEWORK TO RECONCILE ACCESS, EQUITY, AND INNOVATION FOR ON-PATENT MEDICINES IN LMICS
Author(s)
Vaidehi Saini, MPH1, shikhar Mishra, MS2, Venkata Sharmila Uribandi, M Pharma3, Richa Goyal, M Pharma , PhD3.
1School of health system studies, Tata Institute of social sciences, Mumbai, India, 2National institute of pharmaceutical education and research S.A.S Nagar Mohali.INDIA, Shravasti, India, 3Dual Sphere Consulting, Singapore, Singapore.
1School of health system studies, Tata Institute of social sciences, Mumbai, India, 2National institute of pharmaceutical education and research S.A.S Nagar Mohali.INDIA, Shravasti, India, 3Dual Sphere Consulting, Singapore, Singapore.
OBJECTIVES: This study characterizes the limitations of conventional tiered pricing and develops a capacity-calibrated, dynamically re-priced value-based pricing framework that aligns prices with local health value while remaining feasible across varying LMIC institutional capacities.
METHODS: We conducted a structured review of peer-reviewed and grey literature published between 2003 and 2025 using PubMed, Scopus, ISPOR/Value in Health, WHO, BMJ, and Lancet sources. Evidence related to pharmaceutical pricing, value-based pricing, HTA, and market access in LMICs was synthesized alongside comparative analysis of tiered pricing, external reference pricing, and managed-entry agreements. Drawing on opportunity-cost threshold theory and adaptive HTA principles, we developed an AVBP framework and assessed its components against affordability, equity, budget impact, and implementation feasibility criteria.
RESULTS: Core failures of conventional tiered pricing: arbitrary income-band stratification, weak alignment of price with local value, and limited purchaser bargaining power-excluding middle-income populations through binary high/low tiers. Components of the capacity-calibrated, dynamically re-priced AVBP framework:
CONCLUSIONS: AVBP offers a feasible, value-anchored evolution beyond static tiered pricing, reconciling affordability, equity, and innovation incentives-a transparent, capacity-sensitive negotiation tool for LMIC policymakers and HTA agencies, and predictable, value-justified market entry for manufacturers. The essential next step is prospective pilot implementation across diverse LMIC settings to validate the framework under real-world conditions.
METHODS: We conducted a structured review of peer-reviewed and grey literature published between 2003 and 2025 using PubMed, Scopus, ISPOR/Value in Health, WHO, BMJ, and Lancet sources. Evidence related to pharmaceutical pricing, value-based pricing, HTA, and market access in LMICs was synthesized alongside comparative analysis of tiered pricing, external reference pricing, and managed-entry agreements. Drawing on opportunity-cost threshold theory and adaptive HTA principles, we developed an AVBP framework and assessed its components against affordability, equity, budget impact, and implementation feasibility criteria.
RESULTS: Core failures of conventional tiered pricing: arbitrary income-band stratification, weak alignment of price with local value, and limited purchaser bargaining power-excluding middle-income populations through binary high/low tiers. Components of the capacity-calibrated, dynamically re-priced AVBP framework:
- -Anchors launch price to country-specific, opportunity-cost willingness-to-pay thresholds.
- -Adds disease-burden and budget-impact ceilings to safeguard population-level affordability.
- -Embeds iterative re-pricing via outcomes-based managed-entry agreements and confidential rebates.
- -Calibrates implementation to national HTA/data maturity, using adaptive-HTA shortcuts where infrastructure is nascent.
- -Stress-testing suggested that AVBP could improve affordability and equity while maintaining manufacturer incentives through value- and volume-contingent pricing across varying levels of HTA capacity.
CONCLUSIONS: AVBP offers a feasible, value-anchored evolution beyond static tiered pricing, reconciling affordability, equity, and innovation incentives-a transparent, capacity-sensitive negotiation tool for LMIC policymakers and HTA agencies, and predictable, value-justified market entry for manufacturers. The essential next step is prospective pilot implementation across diverse LMIC settings to validate the framework under real-world conditions.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
P37
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Topic Subcategory
Health Disparities & Equity, Pricing Policy & Schemes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas