OBJECTIVES: The aim of this study is to explore Managed Entry Agreements MEA activity, incentives, and issues involved in the actual design, implementation, and evaluation, payers and pharmaceutical decision makers’ perceptions, future outlook, and key success factors for future programs in MENA region. METHODS: We took Algeria, Lebanon, UAE, KSA, Jordan and Egypt as a representative sample of the MENA region. To capture perspective from policy makers and pharmaceutical industry officials, we conducted interviews which were followed by a survey targeted at key stakeholders. This was performed for each country included in the study. The interview questionnaire and Subsequent survey were formulated around the below key objectives:

• To list the types of MEA used in MENA countries.
• To identify the pharmaceutical class (Orphan drug or not) and the disease area that benefit from MEA.
• Have an in-depth understanding about the main incentives from both sides to enter such agreements.

Main challenges encountered during the implementation and evaluation of the MEA RESULTS: The current Managed Entry Agreements are mainly classified as non-outcome, patient and population level based schemes, Especially the price volume agreements; The vast majority of those agreements are implemented in oncology area. The incentives for such agreement are limiting total budget impact on the public side and access to market for promising technology from pharmaceutical side.  CONCLUSIONS: The main barriers are related to the lack of organizational infrastructure and capabilities from both pharma and public to design, implement, and evaluate such schemes; According to professionals in both sectors, the lack of information technology in healthcare, local data collection challenges. However; there are some differences related to healthcare systems and country economy across MENA studies countries that impacted the future outlook of MEA.