OBJECTIVES: What and how we pay for new medicines impacts which therapies are developed, adopted, and accessed. While scientific advancements offer opportunities for better patient outcomes, they also present new challenges for value assessment, affordability and access. Innovative payment models (IPMs) can address payer issues (e.g. payment context, uncertainty or innovation incentives), but a comprehensive framework that matches the spectrum of challenges with the right solution is currently missing. We explore how to enhance the effective use and implementation of IPMs.

METHODS: We conducted targeted literature searches of peer-reviewed and grey literature and synthesised the evidence into a taxonomy of challenges faced in drug pricing/reimbursement and corresponding innovative payment solutions.

RESULTS: There are several existing taxonomies, but no clear mapping of IPMs to the challenges they address. We classified a wide range of payment models, including performance-based agreements, subscription models, indication-specific pricing, and outcome-based contracts. IPMs and the challenges they address do not map one-for-one, meaning that some challenges can be addressed by multiple models and some models serve as solutions for more than one problem. In addition, we identified key case studies within major payment model categories, providing a framework for IPM execution and demonstrating practical solutions for commonly cited implementation barriers.

CONCLUSIONS:

As therapies advance, payment models must keep pace. Our findings contribute to ongoing discussions on drug pricing and reimbursement reform by offering a comprehensive taxonomy of IPMs and the challenges they address. The taxonomy may serve as a resource for payers to navigate the complex landscape of payment models and make informed decisions, along with clear steps to ensure successful implementation. A deeper understanding of IPMs will advance patient access to cost-effective and high-quality medicines and allow health systems to send efficient signals to industry to innovate new medicines and expand uses of existing ones.