New Pricing and Payment Models for Cost-effective and Affordable Health Innovations

This topic aims at supporting activities that are enabling or contributing to one or several expected impacts of destination 6 “Maintaining an innovative, sustainable and globally competitive health industry”. To that end, proposals under this topic should aim for delivering results that are directed, tailored towards and contributing to all of the following expected outcomes:

• Health authorities and insurers adopt new payment models for health technologies, including pharmaceuticals.
• Health industries anticipate better the marketing conditions for innovative health technologies. Patients and health care providers have faster access to innovative health technologies.
• Health authorities, insurers and health care providers have affordable innovative health technologies both on short and longer terms.

Applicants are requested to propose new value-based pricing and reimbursement models that can help ensure equitable access to effective, efficient, affordable, and sustainable health technologies, including medicines, while supporting innovation and industrial competitiveness. The research should tackle the issue globally and be based on a multidisciplinary approach combining economic science, political science and sociology. The proposals should not be limited to the study of cost-effectiveness analyses and thresholds in decision-making. They should also address long term intended and unintended consequences of pricing and reimbursement decisions. Moreover, they should consider the potential limitation of no-coverage decision for products with high budgetary impact. Applicant consortia should include regulators and public entities that are in charge of attributing value tags to health technologies, negotiating with health technology manufacturers and/or reimbursing medical costs. Differences between public and private sectors could be considered, as appropriate. Proposals should also consider citizens engagement and dialogue, for seeking wider input and support, and could encourage other social innovation approaches.

Applicants should propose activities in all of the following areas:

• Affordability of health innovations.
• Variety of pricing/payment schemes in the EU.
• Cost-effectiveness and budget impact (including life-time indirect medical costs).
• Impact of payment schemes (e.g. pay-for-performance/multi-annual instalments) on long-term competition in health technology markets, in particular the pharmaceutical market.
• Potential influence of post-launch evidence-generation plans agreed with regulators and downstream decision makers (HTAs, payers) on the payment models.
• Transparent and comprehensive assessment of technology and medicine development costs, taking into account public investments and incremental character of some innovations (e.g. new indications).
• Development, integration and harmonisation of tools that allow for validation and revision of clinical evidence and cost-effectiveness, and long-term financial planning for effective and transparent decision-making.
• New methods for definition of cost-effectiveness thresholds, integration of greener production and environmental impact, rational applications in real world contexts, comparative analysis of influence in decision-making and influence in the formulation of prices of technologies.
• Potential equity issues derived by payment models and the measures for their mitigation.

Socio-economic science and humanities
Social Innovation