OBJECTIVES: Antimicrobial Resistance (AMR) is a growing public health problem. Antimicrobial stewardship (AMS) promotes the appropriate use of antimicrobials resulting in innovative antibiotics reserved to later-line use, thereby constraining adoption. While push incentives are in place to spur R&D, there are limited effective payment mechanisms post launch. This research will explore the potential of innovative pull mechanisms in LATAM.

METHODS: A literature review was conducted that included publications from the past 3 years to identify pull payment mechanisms. A two-pronged approach to primary research was performed: initially a survey with experts from industry was conducted to shortlist preferred and feasible mechanisms. Subsequently, a virtual iAdBoard was organized with private payers and providers from Argentina, Brazil, Colombia and Mexico (N=3/country) to test stakeholders’ perceptions of the identified mechanisms.

RESULTS: In the literature review, 10 novel payment mechanisms were identified, such as subscription models, outcomes-based agreements, portfolio contracting, treatment cap and DRG carve-out. The subscription model, which the UK has recently pioneered for antibiotics and fully delinks payment from volume used, was likely sparked by its successful adoption for Hepatitis C drugs for CMS-covered patients in two American states. Survey results with Industry representatives revealed preferences for 3 mechanisms: portfolio contracting, treatment cap and the subscription model. Two of these are currently being pressure tested with private payers/providers in LATAM. Results from the iAdBoard will be available at time of presentation.

CONCLUSIONS: To date, limited efforts have been made to modify current P&R practices for novel antibiotics; however, real-life examples in the UK, USA and other developed countries seem promising. There are opportunities to pilot innovative payment mechanisms in emerging markets, especially in LATAM’s private sector. It is still early to determine whether these alternative payment mechanisms will suffice to increase the commercial attractiveness of pursuing novel antibiotics to address AMR.