OBJECTIVES

: Agreements between payers and pharmaceutical/medical device companies are implemented in many countries to address financial and clinical uncertainties. As part of the annual process of updating the National List of Health Services (NLHS), health-plans are allocated a pre-determined governmental budget to cover the use of the new technologies. Health-plans face a considerable financial risk if the utilization is substantially higher than what was estimated at the time of listing. We describe the main characteristics of agreements signed in Israel from 2011 through 2018.

METHODS

: All agreements between the industry and the Israeli health-plans that were implemented as part of the NLHS updating process from 2011 to 2018 were reviewed. Information regarding the type of agreement, the therapeutic indications, its time frame and the total budget involved are presented.

RESULTS

: A total of 56 agreements were signed since 2011. Over the years, there has been an increase in the annual number of agreements, from one in 2011 to 21 in 2018. The proportion of the annual budget allocated subject to these agreements increased from 3% in 2011 to 73% in 2018; 95% of the agreements were financial-based; 89% referred to pharmaceuticals and the reminder to other medical technologies. The therapeutic areas covered were: oncology (41%), hepatitis C (16%), neurology (11%), respiratory (9%), cardiovascular (7%), and other (16%). 63% of the agreements were signed for five-years, 9% were shorter-term agreements and 20% have no time-limit (20%). In 46% of the agreements implemented through 2017, the actual utilization exceeded the pre-specified threshold and the industry reimbursed the health-plans accordingly.

CONCLUSIONS

: The number of agreements and the allocated budget subject to these agreements increase substantially. Most agreements are financial-based that shift the short-term financial risk from health-plans to the industry. Assessing the long-term implications of these agreements on both the health-plans and the industry is still warranted.