Pharma Opinions on the “Payment By Results” Model

The UK National Health Service (NHS) describes Payment by Results (PbR) as a unique payment system under which commissioners pay healthcare providers for each patient seen or treated, taking into account the complexity of the patient’s healthcare needs. For this model to work properly, PbR should have stablished currencies, which NHS describes as the unit of healthcare for which a payment is made, considering patient attendance, hospital stay, duration of the treatment and tariffs set for each currency.

This payment system is now widely used in the UK for admitted patient care, outpatient care, accidents and emergencies and some outpatient procedures. In fact, the government is already looking forward to translating this model to mental health and community services.

MBN has asked about the benefits of this model to leaders of the pharmaceutical industry in Mexico and their points of view help to understand how these model works and how Mexico could adapt to it, too.

“The patient is able to receive an effective treatment, while the government reduces its costs. At a macro scale, these savings allow the sector to reallocate resources. This new payment method is also an effective way to measure the impact of our treatments on patients,” said Fernando Cruz, Country Manager of Novartis. While there is still a long way to fully apply this model in Mexico, Novartis is looking to use it for specific ailments such as multiple sclerosis or blindness caused by diabetic retinopathy.

Director General of Merck Group Mexico José Arnaud Coelho spoke about the main barrier currently holding back PbR adoption in Mexico. “The problem is that even with the right products, authorities always look for discounts instead of looking for better outcomes or an innovative integral solution. Moreover, without the appropriate follow-up or adherence to treatment, products will not have the desired outcome for the patient. Sector’s authorities are not yet addressing that.”

UCB’s Country Lead Omar Lugo said that PbR is a big step for pharma. However, he agrees with Coelho, saying that “to date there is no regulatory framework that allows these kinds of dynamics. There is not a tender process that allows this.”

As for less prevalent diseases, BioMarin’s Country Manager David López said that there are many benefits to this model, “BioMarin has worked through this model in different countries that have clear and regulated frameworks. This patient-centric scheme is beneficial for the government because it allows it to see the value history of each therapy,” said López. He highlighted that AMIIF is already encouraging these innovative models and his worlds also align with former comments about regulatory barriers. “AMIIF has been actively working with different institutions to establish this scheme but in the country, it is hard to establish standardization on medicine effectiveness as the system is very fragmented and each institution has different KPIs.”

According to López, this model is the future for innovative medicines because treatment costs are increasing. “As the largest provider of health in Mexico, the government will sooner or later need to change its investment model to something more thoughtful and personalized” David López concluded.