Terms for how medicine prices are set and negotiated and how patients gain access to new treatments.
A health plan’s advance review of a patient-specific service, medicine or item against coverage criteria before it is provided.
A retrospective payment from a manufacturer to a payer, typically a percentage of price or based on utilisation volume, reducing true net cost.
The specific group of countries whose drug prices are used as the reference point when a country sets its own prices.
An arrangement distributing the financial or clinical uncertainty of a new treatment's real-world performance between manufacturer and payer, often linked to outcomes.
A utilisation management policy requiring a patient to try and fail lower-cost treatment options before a payer covers a pricier alternative.
The price at which a technology's ICER exactly equals a decision-maker's cost-effectiveness threshold, the maximum price still considered an acceptable use of resources.
A pricing strategy charging different prices for the same product across markets, typically calibrated to differences in ability to pay.
A pricing approach setting a treatment's price to reflect its health benefit relative to existing alternatives, often linked to a cost-effectiveness threshold.