The Implementation of Managed Entry Agreements in Central and Eastern Europe: Findings and Implications

Alessandra Ferrario (), Diāna Arāja (), Tomasz Bochenek (), Tarik Čatić (), Dávid Dankó (), Maria Dimitrova (), Jurij Fürst (), Ieva Greičiūtė-Kuprijanov (), Iris Hoxha (), Arianit Jakupi (), Erki Laidmäe (), Olga Löblová (), Ileana Mardare (), Vanda Markovic-Pekovic (), Dmitry Meshkov (), Tanja Novakovic (), Guenka Petrova (), Maciej Pomorski (), Dominik Tomek (), Luka Voncina (), Alan Haycox (), Panos Kanavos (), Patricia Vella Bonanno () and Brian Godman ()
Additional contact information
Alessandra Ferrario: London School of Economics and Political Science
Diāna Arāja: Ministry of Health, Faculty of Pharmacy, Riga Stradins University
Tomasz Bochenek: Jagiellonian University Medical College
Tarik Čatić: Society for Pharmacoecnomics and Outcomes Research in Bosnia and Herzegovina
Dávid Dankó: Corvinus University of Budapest
Maria Dimitrova: Medical University-Sofia
Jurij Fürst: Health Insurance Institute of Slovenia
Ieva Greičiūtė-Kuprijanov: Ministry of Health of the Republic of Lithuania
Iris Hoxha: University of Medicine Tirana
Arianit Jakupi: Independent Consultant
Erki Laidmäe: Head of Insurance Benefit Package, Estonian Health Insurance Fund
Olga Löblová: Central European University
Ileana Mardare: “Carol Davila” University of Medicine and Pharmacy
Vanda Markovic-Pekovic: Ministry of Health and Social Welfare
Dmitry Meshkov: National Research Institution for Public Health
Tanja Novakovic: The Pharmacoeconomics Section, Pharmaceutical Association of Serbia
Guenka Petrova: Medical University of Sofia
Maciej Pomorski: Agency for Health Technology Assessment and Tariff System (AOTMiT)
Dominik Tomek: Slovak Medical University in Bratislava
Luka Voncina: Independent Consultant
Panos Kanavos: London School of Economics and Political Science
Patricia Vella Bonanno: Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde
Brian Godman: University of Liverpool Management School

PharmacoEconomics, 2017, vol. 35, issue 12, No 7, 1285 pages

Abstract: Abstract Background Managed entry agreements (MEAs) are a set of instruments to facilitate access to new medicines. This study surveyed the implementation of MEAs in Central and Eastern Europe (CEE) where limited comparative information is currently available. Method We conducted a survey on the implementation of MEAs in CEE between January and March 2017. Results Sixteen countries participated in this study. Across five countries with available data on the number of different MEA instruments implemented, the most common MEAs implemented were confidential discounts (n = 495, 73%), followed by paybacks (n = 92, 14%), price-volume agreements (n = 37, 5%), free doses (n = 25, 4%), bundle and other agreements (n = 19, 3%), and payment by result (n = 10, >1%). Across seven countries with data on MEAs by therapeutic group, the highest number of brand names associated with one or more MEA instruments belonged to the Anatomical Therapeutic Chemical (ATC)-L group, antineoplastic and immunomodulating agents (n = 201, 31%). The second most frequent therapeutic group for MEA implementation was ATC-A, alimentary tract and metabolism (n = 87, 13%), followed by medicines for neurological conditions (n = 83, 13%). Conclusions Experience in implementing MEAs varied substantially across the region and there is considerable scope for greater transparency, sharing experiences and mutual learning. European citizens, authorities and industry should ask themselves whether, within publicly funded health systems, confidential discounts can still be tolerated, particularly when it is not clear which country and party they are really benefiting. Furthermore, if MEAs are to improve access, countries should establish clear objectives for their implementation and a monitoring framework to measure their performance, as well as the burden of implementation.

Date: 2017
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DOI: 10.1007/s40273-017-0559-4

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