Toumi, M., Jaroslawski, S., Sawada, T., and Kornfeld, . (2017). The use of alternative and patient assessment points in results-based market access agreements: ongoing debate. Appl. Econ Health. Health policy 15, 5-11. doi: 10.1007/s40258-016-0274-x It is difficult to assess the extent to which performance-based MEAs have been successful to date. Few countries have formally assessed their experience. The confidentiality of agreements remains an obstacle to independent evaluation and little public evidence is availab evidence.

However, information from expert interviews and previous studies shows that reports on the Evidence Development (EDC) agreements have so far had a poor record in reducing uncertainty about drug performance. Default payment agreements (PbRs) are still widespread, but they do not always provide evidence of product performance because the data used to trigger payments is not always aggregated and analyzed. The administrative burden of collecting and analyzing drug performance data can also make execution costly. Morel, T., Arickx, F., Befrits, G., Siviero, P., van der Meijden, C., Xoxi, E., et al. (2013). Compatibility of cost and outcome insecurity with the need for access to orphan medicines: a comparative study on entry agreements managed in seven European countries. Orphanet J. Rare Dis. 8:198.

doi: 10.1186/1750-1750-1172-8-198 Confidentiality of performance-based MEAs information versus interest in such informationnumbers countries where information is not confidential and where there is interest in information from other countries, based on interviews with experts from 12 OECD countries (1) who use information based on RESULTS: MEA: Managed Membership Treaty.- Published: Information is readily available in the public domain (z.B. on the Internet). – Unpublished: The information is not publicly available, but is not confidential and may be shared with third parties upon request.1. Australia, Belgium, the Czech Republic, Estonia, France, Hungary, Italy, Korea, Lithuania, the Netherlands, Sweden, the United Kingdom (England only) – information about Australia only relates to ad hoc agreements. Information for England relates only to access to employment agreements (31 agreements under the Cancer Prevention Fund and 4 for other OECD-controlled disease areas) that are publicly available; Not to other patient access systems. Source: Author of the study based on interviews with OECD experts. Entry-level managed agreements are agreements between companies and health care recipients that cover new drugs while facing uncertainty about their financial impact or performance. Financial agreements are used in at least two-thirds of OECD and EU member states. Many of these countries also use results-related agreements, which subordinate coverage, business payments or discounts paid by companies to product performance, but these MEAs are less common. With the help of the European Commission, the OECD has reviewed the experience of countries that have adopted performance measures to date to identify best practices and opportunities to use these agreements in the future. Ferrario, A., and Kanavos, P. (2015).

Management of uncertainty and high prices for new medicines: a comparative analysis of the use of market entry agreements administered in Belgium, England, the Netherlands and Sweden. Soc. Sci. Med. 124, 39-47. doi: 10.1016/j.socscimed.2014.11.003 Despite the lack of evidence, the experience so far with results-based agreements indicates a series of good practices. These are four main themes: note: This taxonomy is based solely on the structure of the agreements. All types of agreements mentioned above may exist not only between companies and health organizations, but also between companies and other types of institutions that constitute a health system, including government agencies or national authorities responsible for making coverage or pricing decisions and/or