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Taxonomy of payment models for

innovative health technologies
Zoltán Kaló
Professor of Health Economics
1) Center for Health Technology Assessment, Semmelweis University
2) Syreon Research Institute

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Financing of new health technologies

Collection of resources Pooling resources Resource allocation

value
conditions
Fundraising Pooling judgement financing timing of
to reduce
methods methods and price route payment
uncertainty
setting

Components of health care financing

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Methods of fundraising
raising
Fund

Premium for Premium for Medical Out of Earmarked Charity for

Taxation public private savings pocket aids and individual
insurance insurance account payments grants patients
Pooling

General Taxation Public insurance Private insurance

risks

Non-governmental Risk-pooling
Resource allocation

Public risk-pooling entity entity

reimbursement)

risk-pooling entities
(Purchasing /

Health technologies and services

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Scope of pooling risks

• Single (centralized) versus multiple (regional or decentralized)
• Within multiple pools
- territorially distinct versus territorially overlapping pools in terms of
service and population coverage
- competing versus non-competing
- population segmentation versus no population segmentation

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R&D trends necessitate more complex payment models

•Combination
•One size of diagnostics,
▪Herbal •Personalised • ATMPs
fits all solutions drugs, digital
Magistral medicines Volume •Mass Value Care technologies Cure • Potentially
and •Genetic
pharma remedies pharma population pharma sequencing pharma •Optimising the pharma curative
cell & gene
health care pathway
•Subpopulations therapies
problems to maximise
outcomes

simple payment models are used complex payment models are needed

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Elements of public coverage of new medicines from

existing pharmaceutical budget

value selection
conditions
judgement of timing of
to reduce
and price financing payment
uncertainty
setting route

• cost-plus • international procurement • conditional (financial or • upfront payment

• internal price referencing • central procurement outcome based) • payment at use
• external price referencing • reimbursement • restricted • annuity / leasing payment
• value based pricing • institutional financing • payment for outcomes
• named patient basis

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Managed entry agreements to facilitate price reduction of medicines on the positive drug list
SIMPLE COMPLEX
financial based outcome based

conditional outcomes
known in advance

coverage guarantee
net price is

fixed discount manufacturer

SIMPLE

(financial or funded diagnostics

free goods)
coverage only for
portfolio deal subgroup of patients

price volume market share conditional treatment patient

on real-world data
discount is based

agreement based agreement continuation level

COMPLEX

(responders only)
utilization manufacturer population
cap funded initial level
treatment
price cap
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Special patient access schemes

• Several countries apply special reimbursement schemes for technologies

beyond the positive drug list*
- National programs in therapeutic areas with public health priority
(e.g. HCV, COVID)
- UK Cancer Drug Fund
- Reimbursement on named patient basis
- Early access programs

* Ref: Löblová O, Csanádi M, Ozieranski P, Kaló Z, King L, McKee M. Alternative access schemes for pharmaceuticals in
Europe: Towards an emerging typology. Health Policy. 2019. 123. 7. 630-634

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Patient access to medicines outside the Positive Drug List

Adapted from: Löblová O, Csanádi M, Ozieranski P, Kaló Z, King L, McKee M.

Today’s research foraccess
Alternative tomorrow’s
schemeshealth
for pharmaceuticals in Europe: Towards an emerging typology. Health Policy. 2019. 123. 7. 630-634.

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