The pricing and reimbursement of multi-indication products can vary considerably across countries. This study aims to capture payer perspectives across 12 countries on current practices of price-setting and paying for medicines with multiple distinct indications.

METHODS

Current and former members of health insurance organisations, healthcare payers or health technology assessment agencies in France, England, Germany, Italy, Spain, Poland, Belgium, Russia, Turkey, the USA, Canada, and Australia were invited to participate in semi-structured interviews. A semi-structured interview guide was developed with a focus on the challenges, opportunities, and future expectations of pricing policy for multi-indication products. Interviews were conducted between June and July 2020.

RESULTS

Payers recognise that current pricing practices may lead to indications not launching within their country, but typically only if there are comparable therapeutic alternatives within the indication. The most common mechanism for pricing multi-indication products is a weighted pricing model, whereby the discounted or net price for a molecule is revised upon launch of a new indication. While complex indication-specific managed entry agreements are possible within Italy and Belgium, payers express a preference for simpler financial arrangements such as discounts. In theory the net price for a molecule could rise under a weighted pricing model in France, Belgium and Italy, but no payer could identify an example of this occurrence. In Spain, launch of a new indication requires additional discounts for a molecule, proportional to the increase in expected revenue.

CONCLUSIONS

Despite growing capacity and infrastructure to track molecule use at indication level, payers express a reluctance to move towards a formal indication-based pricing model, but rely on weighted pricing models, due to a combination of regulatory/legal barriers and high perceived administrative burden. Across all countries, there is a clear preference for simple financial agreements over indication-specific pricing or indication-specific managed-entry agreements.