Exploring alternative funding mechanisms to improve patient access to innovative medicines

BACKGROUND: Despite the existence of universal health coverage for citizens in Thailand, patient access to innovative medicines remains a challenge given the rapid pace of scientific development and high cost of new therapies. Thai policymakers currently focus almost exclusively on incremental cost-effectiveness ratios (ICERs) and budget impact without considering flexibilities for decision-making. Payers are deprived of tools to manage financial and clinical uncertainties resulting in severely restricted access for patients. This research aims to identify the potential funding mechanisms and implementation approaches in the Thai context to improve access to high-cost innovative medicines. METHODS: A research program was conducted in two phases; focus group discussions with 21 key stakeholders and further in-depth interviews with senior Thai key stakeholders. The first phase sought participants’ ranking of the top five selected financing mechanisms according to feasibility and attractiveness. The second phase utilized in-depth interviews to explore implementation approaches within the Thai context. RESULTS: Managed entry agreements (MEAs) and ring-fenced funding for innovative medicines were viewed favorably. These approaches were deemed easier to implement, providing an acceptable balance of risk and effort between all parties in the ecosystem and efficiently improving patients’ outcomes. High-cost innovative medicines for oncology, rare diseases, and life-threatening diseases with no alternative treatments were recommended as prioritized therapy areas for MEAs. A key priority is a need for a framework to implement MEAs into the current Thai health technology assessment (HTA) process. Additional key considerations included the need to integrate innovative funding mechanisms and establish pilot projects to test the viability of MEAs in Thailand. CONCLUSIONS: In conclusion, all participants acknowledged and endorsed using tangible financial-based solutions (MEAs and ring-fenced funding) for Thailand. Prioritizing equal access to innovative medicines by such initiatives will go a long way in promoting a healthier and more productive Thai society.