OBJECTIVES: Market access agreements (MAA) are an accepted tool to increase patient access to innovative medicines and to facilitate reimbursement in high-income markets. Based on this experience, health systems are increasingly embracing outcomes based concepts. Yet, adoption of MAA in emerging middle-income markets appears to be slow. Thus, the aim of this study is to understand challenges and success factors for MAA in emerging markets to overcome potential limitations and to prepare for outcomes based concepts in these geographies.

METHODS: Literature review to analyze MAA from an emerging markets perspective and to understand stakeholders’ perceptions of MAA, particularly in South-Eastern Europe, Middle East, and Africa. In-depth case study research for Serbia, Lebanon, and South Africa based on interviews with local market access experts and secondary data analysis. Cross-case synthesis to compare approaches and to identify common success factors for the implementation of MAA.

RESULTS: Identified success factors for MAA in the analyzed emerging middle-income countries include:

• Shared understanding of local specifics and access hurdles across all involved parties
• Co-creation of tailored solutions that respect local particularities, product specifics, and health system needs
• Minimizing burden of data collection and contract management
• Closely measure and track the impact of the agreement

CONCLUSIONS: Research revealed that fit-for-purpose MAA are an adequate tool to increase patient access to innovative medicines in emerging middle-income countries provided that the aforementioned success factors are considered. Additionally, no evidence could be found that would prevent a future advancement towards outcomes based concepts if key success factors are met.