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  • Writer's pictureInovatie Serviços em Saúde

What are the challenges in ensuring access to high-cost medicines?

Judicialization of healthcare, increased life expectancy versus growth of patients with chronic diseases, incorporation of new technologies. How has this reality impacted health systems? Innovations in healthcare come at a cost, and managers face a challenge ahead: treating patients with the most modern drugs and procedures, without negatively interfering with the sector's sustainability. Furthermore, how can this be accomplished during the numerous emerging technologies entering the market? How to ensure patients' access to high-cost drugs? This issue is increasingly prevalent in both public and private healthcare.

In the public sphere, it is complex to ensure access to high-cost medicine for some, while thousands lack access to basic supplies. In the private sphere, the challenge lies in making these medicines offered by the operators without unbalancing the bills. In many cases, it is possible to dilute the value of this high-cost drug in a portfolio of millions of users. However, that means that smaller operators tend to disappear with the use of new technologies.

In this context, economic health assessments become increasingly important in the incorporation of new technologies. Cost-effectiveness analyzes are essential to enhance the quality of decisions concerning the allocation of funds for healthcare.

However, they are not the only ones to be considered in the incorporation of medicines or new technologies. Experts concur that it is also necessary to evaluate the prevalence and incidence of pathologies and their budgetary impact, keeping in mind that the budget is limited, both in the public and supplementary spheres.

However, there are solutions.

One way to address this issue and help reduce costs, for example, is through collective purchases, which typically result in lower prices. Another practice is the adoption of the disincorporation, where obsolete or replaced technologies are removed from use.

Another solution that has been under discussion for some time, but is progressing slowly in Brazil, is the implementation of sharing agreements, also known as risk-sharing agreements.

In practice, paying sources pay the manufacturer of the innovative technology or medicine only if the product adds value to the patient, thereby sharing the risk associated with the utilization of these new products.

One of the reasons for utilizing risk sharing contracts is to enable patients to access specific technologies without compromising the sustainability of the healthcare system.

These contracts are gaining prominence because they address the ongoing debate regarding whether new technologies are truly delivering disruptive innovations for patients. An analysis conducted by France´s Institut Prescrire in 2018 revealed that none of the newly evaluated drugs were considered highly innovative, and 50% of them did not offer advantages beyond what was really observed with existing drugs.

These contracts can employ a range of mechanisms to address uncertainty about the technology's performance, optimize its utilization, or even minimize its financial impact.

Regardless of what form the agreement takes, the risk will consistently fall on either the manufacturer or the payer, never on the side of the patients. The concept, on the contrary, is that the final public benefits from the possibility of choosing and accessing adequate treatment, without any harm.

Sources consulted

- Healthcare Performance Magazine

- L'année 2018 du medicament, en bref. Rev Prescrire 2019;39(424):142-144.

- Map Solutions

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