OBJECTIVES: Innovative payment and pricing schemes have been proposed as solutions to the problems with the affordability of new health technologies and uncertainty about their long-term effectiveness. However, little is currently known about the nature and scope of these arrangements, or their impact in practice. The objective of this research is to investigate these issues.

METHODS: As part of a Horizon Europe research project on health innovation next generation payment and pricing models (HI-PRIX), we undertook a review of the literature and of health technology assessment (HTA) agency websites to determine the types of schemes either proposed or implemented. These schemes were then classified according to several criteria, such as their purpose, nature, governance, product category, data collection needs, foreseen distribution of risk, and implementation challenges.

RESULTS: ‘Innovative payment and pricing schemes’ were defined as arrangements that go beyond price per pill (or unit) of the technology, simple price/volume agreements or expenditure caps. Twenty-eight innovative pricing schemes have been classified so far. The schemes referred either to pharmaceuticals, vaccines, or medical devices. Most of the schemes were or had been implemented in practice, while 6 were only specified in principle. Among the 28 schemes mapped so far, a significant proportion (36%) were performance-based schemes involving the measurement of health outcomes either at the patient- or population-level. Financial-based models were also common and concerned only expenditures or the volume of use of the technology.

CONCLUSIONS: Available pricing and payment schemes have the potential to offer a comprehensive toolkit to policymakers facing reimbursement and access decisions, highlighting that it is not the scheme per se which is innovative, but rather its application or use in a given context or for a given challenge. The catalogue will populate the Pay-for-Innovation Observatory, that will be made public in December 2023.