OBJECTIVES: Oncology drugs often face strict reimbursement criteria due to high budget impact and lack of robust evidence. Meanwhile, patients are demanding faster access and higher coverage. MEAs are increasingly employed in APAC as a new approach to improve patient access by managing clinical and financial uncertainty. We aim to characterize the oncology MEA landscape in terms of their abundance and agreement types, focus areas, longitudinal trends and pharma players in select APAC countries (Australia, South Korea, Taiwan, New Zealand, Thailand), and to assess payer considerations.

METHODS: A targeted literature review covering the past 10 years was conducted using academic and grey literature, supplemented with insights from in-depth interviews with payers to answer the research question.

RESULTS: Australia has the highest number of MEAs, followed by South Korea and Taiwan, and lastly New Zealand and Thailand. Oncology focus areas are similar across countries, primarily in breast cancer and blood cancers. Between-country differences exist in MEA adoption timelines (Australia and South Korea implemented in 2010 and 2013 respectively while Taiwan’s officially implemented in 2018) as well as in key pharma leaders (Novartis, Roche and Pfizer dominate Australia MEAs while South Korea MEAs are dispersed among several different players). Most MEAs are financial based agreements (~81-97%), comprising refund/expenditure caps, discounts and price-volume agreements, while outcome based agreements amount to <5% in most countries. Despite payer interest in adopting more outcome based MEAs with focus on patient endpoints (progression free survival, overall survival), in practice these are less frequently used due to patient data ownership concerns and implementation complexity.

CONCLUSIONS: The pace and level of oncology MEA adoption as well as key pharma leaders are country dependent. However, MEAs across select countries show similar focus areas and are dominated by financial based agreements, with growing interest in outcome based agreements in MEA-leading countries.