Challenge
High prices for novel speciality drugs are an increasingly topical and urgent issue on the agenda of political decision makers and the international health care community. Governments, and health insurers struggle to find the budgets needed to provide coverage for these expensive medicines.
The Belgian Healthcare Knowledge Centre (KCE) and their Dutch counterpart Zorginstituut Nederland decided to initiate a consultative process to explore potential solutions to this complex societal challenge. The aim of the project was to elaborate future scenarios and to explore more sustainable ways to ensure patient access to safe and effective drugs, while providing strong incentives for innovation and focussing on real health needs.
The scenario project benefited from the active contribution of a carefully selected group of experts and stakeholders from Europe and North America, including patient representatives, industry leaders, academics, regulators, payers, and government representatives. The resulting report presents four coherent scenarios, developed on the basis of in-depth interviews of the experts, followed by two 2-day deliberative workshops in Amsterdam, in March and April 2016.
Our contribution
This was a challenging assignment in many respects. The project timeline was ambitious as it ran parallel to the Dutch Presidency of the European Union. It was critical that we were able to position ourselves as credible counterparts to the high-calibre experts involved in the process. So we started with a brief, intense research phase to update ourselves on pharma industry dynamics and the broader 'access to medicines' debate.
Systems thinking tools were used to analyse the insights from the interviews and provide a solid basis for the scenario development process. Each of the scenarios had to reflect the logic of an alternative public health-guided drug development and pricing system. Which demanded a rigorous 'business modeling' method as a backbone.
We documented the scenarios in a technical report and produced a summary publication, signed by the Belgian and Dutch Ministers of Public Health, accessible to a broad range of stakeholders.
Impact
This project was strategically timed to influence an important debate. In June 2016 the Dutch Presidency of the EU culminated in the EU Council Conclusions on strengthening the balance in pharmaceutical systems in the EU. The European Public Health Alliance (EPHA) notes: "After this point, the public discourse around pharmaceuticals would never be the same again, as with these bold conclusions, EU Health Ministers acknowledged, for the first time ever, a series of imbalances in the pharmaceutical systems in the EU. In other words, they made it clear that the current pharmaceutical business model was no longer sustainable and should be reviewed."
The 'Drug Pricing' scenarios are considered to be an important contribution to this evolving debate and have been cited as a reference document by numerous transnational fora and organisations (including EPHA, the WHO, the OECD and others).
The KCE Annual Report 2016 highlighted: "This innovative report, for which some really ‘out of the box’ thinking has been done, is the result of the work of an international think tank convened by the two institutions. This group has not been afraid to discard some of the paradigms of the current system. It considers medicines as a public good, which should be accessible to everybody without distinction. By organizing this exercise, we participated in a larger, public debate on future drug policies, which is a growing concern worldwide."
"This innovative report, for which some really ‘out of the box’ thinking has been done, is the result of the work of an international think tank convened by the two institutions. This group has not been afraid to discard some of the paradigms of the current system."