OBJECTIVES : Pricing control mechanisms play a critical role in regulating prices of pharmaceuticals and their availability to patients. The US lacks a consistently applied strategy, meaning prices are poorly-controlled and often substantially higher than in other countries. This research aimed to explore current opinions on the use of four pharmaceutical pricing models in the US.

METHODS : A pragmatic literature search was conducted in November 2018 using Google to identify records reporting opinions on the use of tiered formularies (TFs), reference pricing (RP), outcomes-based contracts (OBCs) and the International Pricing Index Model (IPIM) in the US. Three pages of results were screened against prespecified eligibility criteria. Records containing self-directed promotion or evaluation were excluded. Opinions were extracted from eligible records and classified by perspective and positive/neutral/negative status.

RESULTS : A total of 66 sources were identified reporting 190 opinions. OBCs were subject to the greatest number of opinions (77), followed by the IPIM (69), while RP (22) and TFs (22) were discussed less frequently. Opinions were mixed for all four mechanisms; OBCs received the greatest proportion of positive opinions (36%), relative to RP (32%), the IPIM (25%) and TFs (18%). The greatest proportion of negative opinions was reported for the IPIM (59%), while fewer were reported for OBMs (48%), RP (41%) and TFs (32%). OBCs appeared to be favored by payers and manufacturers due to a potential benefit of risk sharing for high-cost drugs and gene therapies. Patients noted that TFs enable drugs savings negotiated by pharmacy benefit managers to be passed onto them.

CONCLUSIONS : There is much discussion regarding the current and future drug pricing situation in the US. Across all perspectives, no clear preferred mechanism could be identified from the data collected in this analysis; however, results indicated that payers and manufacturers might favor some form of OBC, while patients would favor TFs.