OBJECTIVES: To present new reimbursement alternatives for the incorporation of new health technologies in the public system of Ecuador through managed access agreements (MEA).

METHODS: A review of scientific literature carried out in the main databases and three documents selected. The analysis of national data carried out from public repositories of drug prices, use recommendation status, public procurement portal.

RESULTS: It was determined that during the year 2019 the drugs approved for use within the National Health System (NHS) do not present as part of their evaluation process some type of MEA, including those that were approved through a court order. Currently, do not have a government repository that stores the follow-up of those medications approved under special conditions. Most medications entered the NHS with approximately 15% discount from their retail price, a similar condition for all products. There is no additional explicit strategy for those products considered necessary but that present barriers of entry due to their launch price. Negotiation alternatives have identified among those products that presenting different mechanisms of action and the same therapeutic indication.

CONCLUSIONS: The progressive implementation of MEA in the HTA process could be a useful alternative to meet the growing demand for medications for needs that have not yet met, especially for those medications that present clinical uncertainty and have entered the NHS through judicial ways. The MEA of an financial schemes, due to its rapid implementation, could be determined the first alternative for a transparent negotiation process between the pharmaceutical industry and the payers.