Market access

• Aim: To identify and overcome any barrier that prevents your product from being available to any patient that would benefit from its use
• Landscaping and competitor intelligence
• Budget-impact models
• Risk-sharing agreements
• Value-based healthcare and purchasing
• Pricing and reimbursement
• Informs: Sales strategy, pricing, and reimbursement

What is Risk-sharing?

No matter how beneficial, new products always need to gain sales momentum. This can result in delays in both patients and healthcare systems realizing the positive benefits of adopting new healthcare practices. One reason for this delay, is the uncertainty over potential cost increases or loss of efficiencies. To overcome this, risk sharing agreements have been developed. They are a relatively new and innovative payment or reimbursement model that spreads the risk and opportunity between the two key stakeholders: payers and manufacturers. Under a risk-sharing agreement, the manufacturer and payer agree to link reimbursement to the products effectiveness or benefit. The appeal of such “pay-for-performance” agreements is understandable, as the payer only reimburses the manufacturer for the beneficial health outcomes achieved, rather than for provision of products that may or may not be effective and/or used.

In general, a risk-sharing agreement incorporates a planned assessment period, during which the performance of product is tracked. This includes use of a defines set of patient outcomes and a defined patient population. The level of reimbursement is then linked to the number of positive outcomes achieved. In some cases, it may be that the manufacture offers a tiered rebate on its product if the outcomes pledged are not met.

Clearly, a risk-sharing agreement is about the acceptable splitting of risk. Manufacturers, thus, need to calculate how much they can offer a payer in order to access the payers’ market without taking on too much risk. Coreva Scientific are here to help with the scoping of risk-sharing agreements and to build models to quantify the balance in risk between manufacturers and payers.

Further Reading:
Performance-based risk-sharing arrangements—good practices for design, implementation, and evaluation: ISPOR Good Practices for Performance-based Risk-sharing Arrangements Task Force Report.