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Table 2 Definitions and examples of the three types of Market Access Agreements

From: Market access agreements for pharmaceuticals in Europe: diversity of approaches and underlying concepts

MAA Category Commercial Agreement Payment for Performance Agreement Coverage with Evidence Development
Contract type • Discount-based contract • Permanent risk-shifting agreement (outcomes guarantee/insurance) applied on a per-patient basis • Provisional agreement until new, clearly specified evidence develops from a cohort of patients
Collection and analysis of patient health outcomes data by the payer • None • Per patient • Cohort of patients
Timeframe of the MAA • Permanent/not linked to final decision-making • Permanent/not linked to final decision-making based on new robust evidence • Temporary/provisional until new evidence allows making a final decision
Underlying concept (payer perspective) • Reducing pharmaceutical expenditure • Avoiding inefficient expenditure on treating patients who do not respond to a drug and who cannot be identified ex ante (by permanently linking the payment to drug's performance in individual patients) • Reducing uncertainty about drug's real-life effectiveness (by linking a final HTA, reimbursement and/or pricing decision to drug's performance in a cohort of patients, during a defined test period)
Examples • Flat price per patient (regardless of the number of doses administered) • Cost Sharing • Rebate • Discount • Payment for performance • Pay-back for non performance • Temporary coverage on a condition that new evidence reduces uncertainty about a pre-specified health outcome: - Real-life effectiveness - Higher efficacy in a pre-specified subpopulation of patients - Long-term effect - Improved patient's adherence - Reduction of use of health care resources (e.g. hospitalization)