OBJECTIVES: Oncology agents are often launched sequentially across multiple tumour types. Each additional indication is associated with a new health technology assessment, often followed by lengthy price negotiations that can delay patient access to new medicines. We aim to explore different pricing and payment models that may allow for more timely access of oncology agents undergoing indication expansion, without jeopardising the clinical assessment.

METHODS: We reviewed time to access and pricing of multi-indication oncology products and researched potential strategies to accelerate access. We used a survey to understand EU national payer perception of the issue and assess feasibility, acceptability and impact on access of select payment and access models. Survey findings were supplemented with interviews for deeper understanding of the rationale.

RESULTS: Of seven alternative payment models tested for feasibility and acceptability, simple discounts scored highest (5/5; 4.3/5) while subscription-based models scored lowest (2.5/5; 2/5) on both aspects. However, half of respondents considered both could have a positive impact on patient access. In contrast, although price-volume agreements and budget caps are perceived as highly feasible and acceptable (4.2-4.8/5; 4/5), payers expected they could have a negative impact on access. While payers believed more complex models could have a positive impact on access, they are associated with excessive administrative burden, limiting their feasibility. Market archetypes affected acceptability, especially in France and Germany, where pricing is heavily dependent on added clinical value ratings. In addition to payment models, payers suggested early access pathways (EAPs) to ensure access while negotiating price without compromising the rigor of the current processes.

CONCLUSIONS: Payers preferred using pre-existing models such as simple discounts or EAPs, which are considered more manageable than complex, innovative alternatives. Such agreements could be more acceptable in the rare disease space and, once adopted into routine practice, may then be expanded into other indications, including oncology.