Four years after its initial EU market authorisation, NICE recommended Celgene’s Revlimid® as a first-line treatment in transplant-ineligible multiple myeloma patients. Prior to this, appraisal was halted so that  concerns about the Patient Access Scheme (PAS) could be addressed. Under the new PAS, the list price of over £52,000/ patient is heavily discounted and complexity has been resolved.

Revlimid® is another example of how cost-conscious NHS England is, and reflects the growing trend for tightened control of expenditure and budgets related to market access of new healthcare interventions. It also shows that simple discounting alone, despite being the backbone of pricing negotiations between NHS and manufacturers, might not be enough to ensure access for innovative and costly therapies.

Recently, the CEO of NICE, Sir Andrew Dillon, praised the industry as “pulsating with some really fantastic science”, but carried to say: “I am not sure health systems around the world are prepared and I am not sure either that you as an industry have thought enough about how to work with your customers [on these products]."

To this end, healthcare systems and HTA authorities have launched cross-country initiatives to develop new methods for value-based pricing of potential cures. The Institute for Clinical and Economic Review (ICER), NICE and the Canadian Agency for Drugs and Technologies in Health (CADTH) launched an international collaborative initiative in January, inviting ideas and guidance regarding key methodological questions.

Cost of CAR-T therapies re-ignited discussions around new payment and financing models, with focus being shifted towards annuity-based payment models. Under these reimbursement models, instalment payments will be spread over a pre-determined time period and may be based on efficacy/ performance of the intervention. These new models will make up-front costs more manageable and mitigate both mid- and long-term risks for payers, while ensuring access for potentially curative therapies.

However, further collaborative work needs to be done between the industry and healthcare systems to develop a robust framework of potential payment terms and financing options, as annuity payment models can present a range of financial and logistical risks.

The "Netflix model", of a monthly fee for unlimited access to its services, is currently being explored in in Australia and two US states: Louisiana and Washington; for reimbursement of Hepatitis C drugs and is yet to be seen whether this interesting proposition will become the standard practice for reimbursing potentially curative therapies.