Tackling reimbursement challenges to fair access to medicines – introduction to the topic

ABSTRACT

Introduction

Ensuring both financial and physical access to medicines is a challenge for the reimbursement system. How countries are currently tackling this challenge is an issue worth exploring in this review paper.

Areas covered

The review covered three areas of studies such as pricing, reimbursement, and patient access measures. We compared the use and shortcomings of all measures influencing patients’ access to medicines.

Expert opinion

In this work, we tried attempted to outline fair access policies toward reimbursed medicines in a historical manner by researching the measures accepted during different time periods by governments that affect patient access. From the review, it is evident that the countries are following similar models with a focus on pricing measures, reimbursement measures, and measures directly affecting the patients. It is our opinion that most of the measures are focused on ensuring the sustainability of the payer’s funds and less are those that stimulate faster access. Even worse, we found that studies that are measuring the real patients access, and affordability are scarce.

KEYWORDS:

• Patient access
• pricing
• reimbursement
• medicines
• managed entry agreements
• reference pricing
• health technology assessment

Article highlights

• Countries apply different measures to improve patient access to medicines, but most of them are primarily aimed at containing the cost for payers.

• New approaches as managed entry agreements, fair pricing, and joint health technology assessment will benefit the earlier access to innovation. The patients’ access to medicines needs further studies. Researchers are working on the development of objective measures for evaluating the real patients’ access.

• Policies for generic and biosimilar support ensure access to low-cost medicines with proven quality safety, and efficacy.

• Managed entry agreements and joint health technology assessment are trying to provide evidence for faster access to innovative medicines.

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.

Additional information

Funding

This paper was not funded.