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KMID : 1170320100160020125
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Korean Journal of Health Economics and Policy
2010 Volume.16 No. 2 p.125 ~ p.153
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Risk-Sharing Agreement on the Pricing and Reimbursement of New Drugs
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Park Sylvia
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Abstract
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Recently, there has been increasing interest in a new coverage and reimbursement schemes for new drugs, which involve the concept "pay-for-performance" and "risk-sharing". Faced with challenges from new drugs with promising effectiveness but with insufficient evidence and pressure on health care budget, third-party payers in developed countries have tried the new evidence-based pharmaceutical pricing and reimbursement system which is called risk-sharing agreement. Under the risk-sharing agreement, drug companies agree to refund the cost if a drug fails to meet agreed performance targets when used under appropriate conditions. This study introduces three types of the scheme: performance-linked reimbursement; conditional treatment continuation; coverage with evidence development. Risk-sharing agreement has the potential to reduce risk in health care decisions in times of new health technology and to ensure predictable health gains for a given drug expenditures. However until now it has not gained wide-spread acceptance because of its feasibility issues. Moreover it has not been fully evaluated yet. Risk-sharing agreement should thus be considered only for a few innovative drugs treating life-threatening diseases, for very specific target populations as an option to deal with insufficient evidence and to ensure access to essential medicines.
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KEYWORD
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new drugs, pricing, reimbursement, risk-sharing, evidence, decision-making
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