title: Patient access schemes in Asia-pacific markets: current experience and future potential.
abstract: OBJECTIVE
  Patient access (or risk-sharing) schemes are alternative market access agreements between healthcare payers and medical product manufacturers for conditional coverage of promising health technologies. This study aims to identify and characterize patient access schemes to date in the Asia-Pacific region.
  
  
  METHODS
  We reviewed the literature on patient access schemes over the last two decades using publicly available databases, Internet, and grey literature searches. We extracted key features of each scheme identified, including the drug, clinical indication, stakeholders involved, and details of the scheme. We categorized schemes according to a previously published taxonomy of scheme types and by country.
  
  
  RESULTS
  We identified 3 schemes in South Korea, 5 in New Zealand, and 98 in Australia. Most (97.2%; n = 103) schemes focused on pharmaceuticals, few on medical technologies. More than half of the schemes related to treatments for cancer and inflammatory diseases such as rheumatoid arthritis. The majority (77.4%; n =82) involved pricing arrangements. Evidence generation schemes were rarely used. About half (41.8%; n = 41) of schemes in Australia were hybrid by nature, consisting of pricing arrangements with a conditional treatment continuation component.
  
  
  CONCLUSIONS
  Australia has the most experience with patient access schemes and its experience may provide useful insights for other Asia-Pacific countries. The main targets are pharmaceuticals likely to have high budget impact (due to high per-patient costs and/or large volumes of use), and pharmaceuticals that may be adopted more widely than indicated. With the proliferation of high-cost medicines, the use of schemes may increase to address rising cost pressures, consumer demands, and uncertainties, while attempting to provide patient access to innovative care within finite budgets. Future research is warranted to evaluate the performance of patient access schemes.
authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA.
authors: Christine Y
authors: CY
authors: Lu
authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA.
authors: Caitlin
authors: C
authors: Lupton
authors: Jefferson Medical School, Philadelphia, USA.
authors: Shana
authors: S
authors: Rakowsky
authors: School of Pharmacy, University of Auckland, Auckland, New Zealand.
authors: Zaheer-Ud-Din
authors: ZU
authors: Babar
authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA.
authors: Dennis
authors: D
authors: Ross-Degnan
authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA.
authors: Anita K
authors: AK
authors: Wagner
keywords: Access to medicines; Conditional coverage; Health technology assessment; High cost medicines; Managed entry; Patient access schemes; Risk sharing