ENSURING CONTINUITY OF ACCESS TO HIGH-COST INNOVATIVE THERAPIES DURING QATAR'S MANDATORY HEALTH INSURANCE TRANSITION: EXPERT STAKEHOLDER PERSPECTIVES
Author(s)
Anas Hamad, MSc, PhD1, Abdulrazak Aljazairy, PhD2, Dina Abushanab, PhD3, Holger Thies, MBA4, Hussam Irshied Muhidat, MSc5, Mohammad Naser Fargaly, PhD6, Mohamed Tannira, BSc, MSc7, Nadia Al Mazrouei, PhD8, Sahar Fahmy, PhD9, Samar Mansour, PhD7, Daoud Al-Badriyeh, PhD10.
1Drug Supply Department, Hamad Medical Corporation, Doha, Qatar, 2Clinical Trials Transformation Initiative Division, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, 3QU Health Sector, Qatar University, Doha, Qatar, 4Independent Researcher, Magdeburg, Germany, 5PriceWaterhouseCoopers Middle East, Doha, Qatar, 6Dubai Medical College, Dubai, United Arab Emirates, 7ISPOR UAE Chapter, Dubai, United Arab Emirates, 8Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates, 9Department of Health, Abu Dhabi, United Arab Emirates, Abu Dhabi, United Arab Emirates, 10College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
1Drug Supply Department, Hamad Medical Corporation, Doha, Qatar, 2Clinical Trials Transformation Initiative Division, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, 3QU Health Sector, Qatar University, Doha, Qatar, 4Independent Researcher, Magdeburg, Germany, 5PriceWaterhouseCoopers Middle East, Doha, Qatar, 6Dubai Medical College, Dubai, United Arab Emirates, 7ISPOR UAE Chapter, Dubai, United Arab Emirates, 8Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates, 9Department of Health, Abu Dhabi, United Arab Emirates, Abu Dhabi, United Arab Emirates, 10College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
OBJECTIVES: To evaluate strategies for maintaining care continuity and ensuring equitable, sustainable access to high-cost innovative therapies within the context of Qatar’s mandatory health insurance transition.
METHODS: A formal, two-round, consensus-driven expert panel was convened comprising 12 multidisciplinary stakeholders (regulatory, payer, HTA, economic, provider, and patient-support) from Qatar and the MENA region. The framework addressed 10 core domains, including benefit design, value assessment, and RWE infrastructure. Consensus was defined a priori as ≥85% agreement on thematic recommendations via quantitative scoring. Qualitative insights were synthesized using content analysis to determine overarching strategic imperatives.
RESULTS: Consensus was achieved across all prioritized domains. Recommendations reaching ≥90% agreement included: Financing & Reimbursement: Implementing outcome-based and managed entry agreements (95% consensus) to balance annual budgets with long-term clinical gains. Continuity of Care: Maintaining uninterrupted access for existing patients as the foundational requirement of the reform (90% consensus). Infrastructure: Establishing national patient registries and standardizing EMR-based clinical pathways (90% consensus) across public-private sectors. Support Systems: Funding patient support programs for diagnostics and laboratory testing via public-private partnerships (88% consensus) to mitigate cost-shifting. Value Assessment: Expanding value definitions to incorporate broader societal and system-level impacts (85% consensus) rather than narrow clinical metrics.
CONCLUSIONS: Qatar’s mandatory health insurance transition acts as a strategic enabler for value-based reimbursement. Through centralized design, adaptive value frameworks, and robust data infrastructure, the country can achieve a resilient access model for high-cost therapies.
METHODS: A formal, two-round, consensus-driven expert panel was convened comprising 12 multidisciplinary stakeholders (regulatory, payer, HTA, economic, provider, and patient-support) from Qatar and the MENA region. The framework addressed 10 core domains, including benefit design, value assessment, and RWE infrastructure. Consensus was defined a priori as ≥85% agreement on thematic recommendations via quantitative scoring. Qualitative insights were synthesized using content analysis to determine overarching strategic imperatives.
RESULTS: Consensus was achieved across all prioritized domains. Recommendations reaching ≥90% agreement included: Financing & Reimbursement: Implementing outcome-based and managed entry agreements (95% consensus) to balance annual budgets with long-term clinical gains. Continuity of Care: Maintaining uninterrupted access for existing patients as the foundational requirement of the reform (90% consensus). Infrastructure: Establishing national patient registries and standardizing EMR-based clinical pathways (90% consensus) across public-private sectors. Support Systems: Funding patient support programs for diagnostics and laboratory testing via public-private partnerships (88% consensus) to mitigate cost-shifting. Value Assessment: Expanding value definitions to incorporate broader societal and system-level impacts (85% consensus) rather than narrow clinical metrics.
CONCLUSIONS: Qatar’s mandatory health insurance transition acts as a strategic enabler for value-based reimbursement. Through centralized design, adaptive value frameworks, and robust data infrastructure, the country can achieve a resilient access model for high-cost therapies.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA42
Topic
Health Policy & Regulatory, Health Service Delivery & Process of Care, Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas