OBJECTIVES: To provide a commentary on outcomes-based risk-sharing schemes in Europe and the US, and to assess characteristics of such schemes and whether they have a potential role in the Asia-Pacific markets. This commentary also examines current experience in the Asia-Pacific markets and considers criteria for such agreements as they might relate to the different health care environments. SUMMARY: Future opportunities for patient access schemes, and specifically, a role for outcomesbased risk-sharing schemes, exist in the Asia-Pacific markets. Four types of agreements across the Asia-Pacific markets were identified that are not purely outcomes-based or risk-sharing, but cover innovative high-cost medicines, areas of high unmet need, areas affecting small patient populations, and medicines where the evidence is uncertain. Key factors for consideration are the public environment and the general acceptance of such agreements; the level of available resources that impact the health care priorities in each market and the public demand for access to medicines and to innovation. The ability to undertake such agreements appears to depend significantly on the degree of centralized decision-making and the dominance of a "single payer" for negotiation; the ability to manage data - both to undertake health technology assessments and to have systems/infrastructure to collect data and demonstrate outcomes; the nature of local health care structures and the capabilities to implement schemes where the financing is linked to outcomes. Caution was shared across markets with a trend to "watch and wait" while evidence emerges elsewhere.
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