An evaluation of managed entry agreements in Belgium: A system with threats and (high) potential if properly applied. Issue 9 (September 2020)

• Record Type: Journal Article
• Authors: Neyt, Mattias; Gerkens, Sophie; San Miguel, Lorena; Vinck, Irm; Thiry, Nancy; Cleemput, Irina
• Is Part Of: Health policy. Volume 124:Issue 9(2020)
• Page Start: 959
• Page End: 964
• Publication Date: 2020-09
• Subjects: Insurance, health, reimbursement -- Insurance, pharmaceutical services -- Contracts -- Cost control -- Data collection -- Antineoplastic agents; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2020.06.007
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: Based on an analysis of Belgian MEAs, the long-term efficiency of wide MEA use for the payer is unclear. MEAs might not provide incentives to manufacturers to gather more reliable evidence. Systematic use of MEAs runs the risk of making the system non-transparent. MEAs should not be the standard. Focus on well-considered cases is needed. International collaboration is needed for requesting further information and (public) price negotiations. Abstract: Objective: To evaluate the strengths and weaknesses of managed entry agreements (MEAs) in Belgium. Methods: All Belgian MEAs signed between 2010 and 2015 (n = 71) were studied, including the re-evaluations of 16 reimbursement requests for which the initial MEA had ended. The analysis was supported by the findings from a systematic literature review and structured interviews with Belgian stakeholders. Results: The current application of MEAs provides the short-term advantage of getting a positive reimbursement decision with lower confidential prices. However, it is not clear whether the negotiated prices are in line with the added value of the interventions. Furthermore, the contracts do not provide incentives for manufacturers to gather evidence or to set public prices at an acceptable level. Conclusions: Based on our analysis of the Belgian MEAs and discussions with Belgian stakeholders, an overview of various issues and pitfalls related to the current application of the system is given. Recommendations are made related to providing correct incentives to deliver good evidence, establishing a correct link between identified uncertainties/problems and the type and content of the MEA, reducing the risk of making the system non-transparent, the importance of international collaboration, etc. in order to optimize the potential of this system. These recommendations are addressed to both the Belgian policymakers and stakeholders in other countries making use of MEAs.