Strengthening health technology assessment in Greece: industry-identified barriers and recommendations

Objective: This qualitative study explores pharmaceutical industry stakeholders' perspectives on Health Technology Assessment (HTA) in Greece and its perceived implications for public reimbursement decision-making. Since 2018, the Greek Committee for the Evaluation and Reimbursement of Medicines for Human Use has played a central role in recommending medicines for inclusion in the national reimbursement list. Understanding the views of a key HTA stakeholder group provides insight into how the post-2018 HTA and negotiation pathway is experienced in practice and how it is perceived to support timely, evidence-informed decision-making. Methods: Seventeen senior Market Access executives from pharmaceutical companies were recruited through purposive sampling and interviewed using a semi-structured interview guide. Data were analyzed using thematic analysis, with iterative coding and theme refinement to support analytical rigor. Results: Nine themes were identified, reflecting participants' concerns regarding the HTA Committee's staffing capacity, technical expertise, and transparency. Additional challenges described by participants included legislative misalignment, bureaucratic inefficiencies, limited stakeholder engagement, and delays associated with complex and multi-criteria assessment processes. Additionally, participants proposed fifteen (15) targeted recommendations aimed at strengthening HTA implementation in Greece. Conclusion: The findings provide stakeholder-informed insights relevant for policymakers seeking to enhance Greece's HTA framework. As perceived by participants, priorities include strengthening governance and independence, addressing capacity and skills gaps through structured development, clarifying evaluation criteria, increasing transparency, enabling more meaningful stakeholder participation, and advancing digitalization. These improvements have the potential to support more consistent, evidence-informed reimbursement decisions, facilitate timely access to innovative therapies, and contribute to healthcare system sustainability.