Could the pay-for-performance model replace rebate negotiations?

Pay-for-performance deals could be replacing rebate negotiations for medicines hinted a GKV-Spitzenverband (National Association of Statutory Health Insurance Funds) representative.

This comes in the context of an increasing use of pay-for-performance models for highly specialised technologies, but challenges remain on whether a broader application of this approach is practical.

MAP has previously reported on this trend within specialised drugs, with the news of Kymriah’s managed access entry agreement. Further pay-for-performance agreements have been made for Yescarta, for relapsed or refractory diffuse large B-cell lymphoma (DLBCL) and primary mediastinal large B-cell lymphoma.

Earlier in the year Wolf-Dieter Ludwig, Chairman of the Arzeimittelkommission der deutschen Ärzteschaft (AkdÄ), the Drug Commission of the German Medical Association, stated in an interview that the pay-for-performance may be appropriate for orphan and cancer drugs as well as biologics. This is because complete relevant data are not available at the stage these medicines are being considered for reimbursement.

But Ludwig highlights some potential issues with gene therapies, including the challenges created by population heterogeneity and due to patients undergoing other treatments such as chemotherapy or stem cell transplantation.

The original interview can be read here (in German).

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Published 12. June 2019 in Interesting Reads, News, News Germany