How to Expand Access to Healthcare Innovation

In recent years, innovative technologies with the potential to revolutionize health care have been developed. However, the problem of their access and implementation still persists. "Gene therapy or CAR-Ts are undoubtedly promising and have shown good results in clinical trials. The problem, however, is that they cost hundreds of thousands euros," says Oriana Ciani, Associate Professor of Practice at SDA Bocconi School of Management and Principal Investigator of Health Innovation Next Generation Payment & Pricing Models (HI-PRIX), a research project that obtained funding worth ca. €5.2mln from the European Union's Horizon program.

The HI-PRIX project aims to address the mentioned issue by formulating new pricing and payment schemes. This would help health systems in Europe and around the world, which are struggling with the need to guarantee access to these innovations to all individuals who might need them.

"Many advanced therapies, for example," Professor Ciani says, "consist of a single administration, which benefits the patients for the rest of their life. If paying hundreds of thousands of euros upfront is unaffordable, we could think of multi-annual instalments, or of insurance-like risk-pooling, but we also need to rethink public reimbursement policies."

Another challenge that HI-PRIX tries to address is the transparency of the funding obtained from governments or nongovernmental associations during the phase of research and development. For example, in the case of COVID vaccines, many governments contributed to the development and production of the vaccines. However, this help did not translate into an influence on the price that was agreed upon.

Moreover, there are disease areas where a diminishing pipeline of new products emphasizes the need to incentivize new research and development also through promising pricing formulas. In the case of antibiotic discovery, one could decouple payments from the volume sold and, instead, reward pharmaceutical companies for the development of novel antibiotics with regular payments based on their overall value to society.

The booming case of digital health solutions, together with the process of care they are embedded in, is an interesting one and might favor non-linear payment systems, including price-volume agreements, bundled payments, and population-based approaches to be applied by insurers, providers or health care organizations.

A single payment model is not going to provide an effective answer in every situation, but this project tries to formulate pricing models fit for a variety of different technology classes, therapeutic areas, settings, and healthcare systems and to test their impact at different levels: patient access, equity, competitiveness, and innovativeness for the system.

HI-PRIX is a 3-year project, which will start officially in January 2023, involving researchers from Bocconi (Rosanna Tarricone and Claudio Jommi), UC Berkeley (James Robinson), and University of York (Mike Drummond), other academic institutions across Europe and regulators and public entities in charge of attributing value tags to health technologies, negotiating with manufacturers and/or reimbursing medical costs.

Horizon Europe is the EU's key funding program for research and innovation until 2027 with a budget of €95.5 billion.