Risk sharing or risk shifting? On the development of patient access schemes in the process of updating the national list of health services in Israel

ABSTRACT

Background: Agreements between payers and pharmaceutical/medical device companies are widely implemented to address financial and clinical uncertainties. We analyzed the main characteristics of these agreements in Israel from 2011–2018.

Research design and methods: We reviewed all agreements implemented during the study period. Information regarding the type of agreement, therapeutic indications, its time frame and the total budget involved are presented.

Results: A total of 56 agreements were signed since 2011, of which 53 (95%) were financial-based and 50 (89%) referred to pharmaceuticals. The annual number of agreements increased from one in 2011 to 21 in 2018. The main therapeutic areas covered were: oncology (41%), hepatitis C (16%), neurology (11%), respiratory (9%), and cardiovascular (7%). The proportion of the annual budget allocated subject to these agreements increased accordingly from 3% in 2011 to 73% in 2018. The majority (63%) of the agreements were signed for 5 years, 9% were shorter-term and 20% have no time-limit. In 14 (44%) of the financial-based agreements implemented through 2017, the actual utilization exceeded the pre-specified threshold and the companies reimbursed the health-plans accordingly.

Conclusions: The number of agreements and the allocated budget subject to these agreements increased substantially in recent years. Most agreements are financial-based that, in many cases, shifted the short-term financial risk from health-plans to the industry.

KEYWORDS:

• Cost
• coverage
• reimbursement
• risk-sharing
• risk-shifting
• technology

Article Highlights

• The use of risk-sharing agreements in the process of updating the National List of Health Services in Israel emerged rapidly in recent years and allows patient access to innovative technologies.

• Most of the budget allocated to cover new technologies in Israel is subject to risk-sharing agreements, and the vast majority of agreements are financial-based.

• In many cases, the agreements shift the short-term financial risk from health-plans to the industry.

• In approximately half of the financial-based agreements implemented through 2017, the actual utilization of technologies exceeded the pre-specified threshold and the pharmaceutical/medical device companies reimbursed the health-plans accordingly.

• Assessing the long-term implications of these agreements on both the health-plans and the industry is still warranted.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contribution statement

All authors were involved in the conception and design of this study, as well as interpretation of the data. NT performed the analysis. NT, AH, and DG drafted the manuscript and all authors revised it for intellectual content. All authors have reviewed and approved the final version of this manuscript and agree to be accountable for all aspects of this work.

Additional information

Funding

This paper was not funded.