Development of patient access schemes

The high prices charged for many new drugs have led to many health systems requiring proof of cost effectiveness before they are funded. However, decisions often have to be made with limited information: licensing trials are typically short term and of little value for assessing cost effectiveness. Once licensed, drug prices are listed at prices that seldom change. Patient access schemes have developed whereby agreements are made with the manufacturer to vary drug prices according to factors such as the number of patients treated or doses used, the response of the patient, or longer term patient outcomes.

The 2009 Pharmaceutical Price Regulation Scheme, which governs drug pricing, outlined two types of access scheme: those based on finance and those based on outcomes (table⇓).4 Schemes based on finance involve either changes in list price or discounts linked to the number of patients or doses or to patient responses. Schemes based on responses can …