OBJECTIVES: Breakthrough therapies are usually associated with high prices raising affordability concerns. To address these concerns, several innovative payment models for high-price therapies have been proposed in the literature. The aim of this study was to identify payment models that may likely be adopted from payers’, manufacturers’, and healthcare providers’ perspectives.

METHODS: A systematic review was conducted in Medline and Embase to identify innovative funding models proposed. To compare the identified models, a consensus meeting was organized with 7 participants: 2 academics, a hospital pharmacist, a former payer, a pricing director from the pharmaceutical industry, and 2 consultants in pricing and market access. The feasibility, acceptability, burden, financial attractiveness, appeal to payers, and appeal to manufacturer of each model were assessed during the meeting.

RESULTS: Innovative payment models proposed in the literature were mainly: financial agreements (discounts, rebates, price and volume caps, price-volume agreements, loans, cost-plus pricing, intellectual-based payment (prizes for patents), pooled funding, national silo funds (e.g. cancer drug fund)), health outcomes-based agreements and healthcoin. The least feasible and acceptable payment models were: credits for patients, cost-plus pricing, intellectual-based payment, pooled funding and healthcoin. Almost all models were associated with additional burden, except for rebates and discounts. All models except intellectual-based funding could be considered appealing to payers and the model the most appealing to manufacturers was: national silo funds.

CONCLUSIONS: As a large number of ATMPs are currently in development, it is time for stakeholders to embrace new funding strategies for these high-price therapies. A specific fund with clearly defined eligibility criteria in addition to cost-containment measures may constitute a reasonable and practical solution. This approach ensures patient access to innovation without threatening the financial sustainability of the health insurance.