PRICE NEGOTIATION FOR HIGH-COST THERAPIES: A REVIEW OF THEORIES, STRATEGIES AND FACTORS INFLUENCING BARGAINING POWER
Author(s)
Joana R. B. Carvalho, MSc, Claudia Imaz, MSc, Madelon Voets, MSc, PhD, Valesca P. Retel, MSc, PhD, Willem Herbert Van Harten, MD, PhD.
Netherlands Cancer Institute (NKI-AVL), Amsterdam, Netherlands.
Netherlands Cancer Institute (NKI-AVL), Amsterdam, Netherlands.
OBJECTIVES: Improving negotiation strategies and strengthening the position of negotiators are crucial steps toward ensuring timely, equitable, and affordable access to innovative therapies. We aimed to identify theories and factors that influence negotiation outcomes in the pharmaceutical sector, with a particular focus on negotiation strategies that enable access to high-cost drug therapies.
METHODS: Following the Joanna Briggs Institute methodology for scoping reviews, we conducted a literature search across EconLit (EBSCO), EMBASE, PubMed, Scopus, and Web of Science. The search covered literature published from 2010 onwards. Study selection was based on relevance to price negotiations for high-cost, innovative medicines or therapies. Abstract and full-text screening, as well as data extraction, were performed by one reviewer and independently quality checked by a second.
RESULTS: Of the 2416 studies screened, 84 were included. Among these, approximately 49% focused on European contexts, 21% on global or intercontinental settings, 20% on non-European countries, and 10% did not specify a geographic location. While Nash bargaining grounds overall negotiation dynamics, welfare economics explains the structural tension between health system cost containment and manufacturer R&D incentives. Simultaneously, behavioural concepts like anchoring, framing, loss aversion and reputation may shape initial positioning, price offers and negotiation evolution. Reflecting unique pharmaceutical dynamics, influencing factors were grouped into five categories: clinical value, economic value, market and competition, regulatory policies, and institutional frameworks. A range of negotiation strategies were also identified, including bundling, volume-based agreements, and the use of more complex managed entry agreements.
CONCLUSIONS: This review emphasises the importance of considering behavioural, structural, and product-specific factors while negotiating medicine prices. Negotiation success for both stakeholders relies on balancing these elements. A deeper understanding of the pharmaceutical negotiation processes can support the development of targeted corrective strategies.
METHODS: Following the Joanna Briggs Institute methodology for scoping reviews, we conducted a literature search across EconLit (EBSCO), EMBASE, PubMed, Scopus, and Web of Science. The search covered literature published from 2010 onwards. Study selection was based on relevance to price negotiations for high-cost, innovative medicines or therapies. Abstract and full-text screening, as well as data extraction, were performed by one reviewer and independently quality checked by a second.
RESULTS: Of the 2416 studies screened, 84 were included. Among these, approximately 49% focused on European contexts, 21% on global or intercontinental settings, 20% on non-European countries, and 10% did not specify a geographic location. While Nash bargaining grounds overall negotiation dynamics, welfare economics explains the structural tension between health system cost containment and manufacturer R&D incentives. Simultaneously, behavioural concepts like anchoring, framing, loss aversion and reputation may shape initial positioning, price offers and negotiation evolution. Reflecting unique pharmaceutical dynamics, influencing factors were grouped into five categories: clinical value, economic value, market and competition, regulatory policies, and institutional frameworks. A range of negotiation strategies were also identified, including bundling, volume-based agreements, and the use of more complex managed entry agreements.
CONCLUSIONS: This review emphasises the importance of considering behavioural, structural, and product-specific factors while negotiating medicine prices. Negotiation success for both stakeholders relies on balancing these elements. A deeper understanding of the pharmaceutical negotiation processes can support the development of targeted corrective strategies.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR38
Topic
Health Policy & Regulatory
Topic Subcategory
Pricing Policy & Schemes, Public Spending & National Health Expenditures, Reimbursement & Access Policy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas