OBJECTIVES

: To understand current and future payer approaches to assessing the value of a product and understanding, in ever increasingly competitive markets, the different approaches payers will enforce to get the best treatments at the best prices.

METHODS

: A web-based survey administered via the Rapid Payer Response™ online portal (RPR®) to 48 payers with experience in contract, tendering and reimbursement across Europe. Payer profiles included ex-NICE (UK), ex-CEPS and ex-TC (France), ex-G-BA and SHI (Germany); ex-national and regional payers (Italy and Spain), ex-TLV (Sweden) and ex-CVZ (the Netherlands).

RESULTS

: Payers utilise a range of approaches to procure treatments based on value metrics, from tendering to payment-by-results. In all countries, value is intrinsically linked to innovation; if a product truly offers an innovation, then it should also be efficacious. Payers are clear that contracting/tendering should not hindered innovation, but definitions of innovation vary widely. Safety and cost are also key areas, with new products needing to demonstrate maintained or improved safety, and the sum of gains should be traded against the cost.

The mechanisms to truly utilise value-based procurement are largely only employed at regional and local levels, with individual hospitals entering into direct negotiations with manufacturers. Of all countries, payers from the UK reported the strongest positive perception of value-based purchasing, considering it a more sophisticated system-cost model. Spanish and regional Italian payers demonstrated greater scepticism, stating that while contracting occurs widely, value-based negotiations are an administrative burden, and straight volume-based deals will continue to dominate.

CONCLUSIONS

: Payers from national to local, strive to pay for what a drug can offer in terms of patient, and ultimately system benefits. Each new product offers a different value story, and communicating this clearly, and refining value perceptions alongside simple contracting methods will ultimately drive positive uptake.