OBJECTIVES: Managed Entry Agreements (MEAs) are usually implemented when there are uncertainties about the clinical and financial impact of health technologies. If the role of MEAs is well defined, better patient access to innovative health technologies can be achieved. Our objective was to assess the current status of MEA implementation to support pharmaceutical reimbursement decisions and to set up long-term objectives in Egypt.

METHODS: A survey was designed and distributed in an electronic format to healthcare stakeholders and key decision-makers in Egypt.

RESULTS: 25 participants working in the Egyptian healthcare sector responded to the survey during February – March 2020. Participants mainly represented the public healthcare sector (80%). Participants generally thought that MEAs are currently underutilized in the reimbursement decisions and prefer expanding the role of MEAs in the future. Participants would like to use MEAs not only for new pharmaceuticals but also for the revision of previously reimbursed products, with special focus on chronic and genetic treatments. Participants recommend the gradual introduction of outcome-based agreements without compromising financial-based agreements except for fixed discounts and coverage only for a subgroup of patients. There was a consensus (80%) that MEAs should be initiated by either the payer or the manufacturer.

Moreover, 56% of the participants thought that MEAs should be fully confidential in the future to prevent the cascade of external referencing. Three years was considered the preferred contract length of MEAs in the future. The lack of legislative framework, limited availability of patient registries and lack of mutual trust between stakeholders were reported as major hurdles of MEA implementation.

CONCLUSIONS: In general, increased utilization of MEAs have the potential to improve patient access to innovative technologies in Egypt. Gradual implementation through successive pilots in different areas would be an appropriate approach to explore how hurdles can be considered and tackled.