OBJECTIVES: Managed entry agreements (MEAs) for prescription drugs have been available in Sweden through three-party deliberations since 2015, and by April 2018 39 MEAs had been formed. The standardized content of the agreements has evolved over time. The objective of the project is to get an understanding on the views of the manufacturers involved in MEAs of the content of the agreements and to identify areas with potential for improvement.

METHODS: Semi-structured interviews with pharmaceutical companies centered on their views on the content of the MEAs were conducted. The interviews were made in collaboration with LIF, the trade association for the research-based pharmaceutical industry in Sweden. In a subsequent focus group discussion with the companies, areas with potential for improvement were ranked for importance by consensus.

RESULTS: 15 companies agreed to participate in interviews (including 1 LIF non-member). Altogether, interviewees had experience from 64% of the MEAs available in April 2018. The areas with potential for improvement were the following (ranking by importance):

1. Flexibility in the structure of the risk sharing models
2. Legislation around parallel import
3. Patient value and competition
4. Services in return
5. Confidentiality
6. Contract period and renegotiations

CONCLUSIONS: The most important area in current Swedish MEAs for prescription drugs with potential for improvement from the companies’ perspective is the flexibility in the structure of the risk-sharing models. It is perceived by the manufacturers that the agreements have little or no connection to the risks that are identified by the payers. The companies wish for agreements that are coupled to the identified risks, e.g. outcome-based agreements. Such agreements would be easier to be endorsed by the companies on the global level, will not require the same degree of confidentiality and are likely to lead to bigger refunds to the payers.