(((“Patient Access Scheme” [All Fields] OR (“Pharmacy” [MeSH terms] OR “Pharmacy” OR “Pharmaceuticals” OR “Dosages” [MeSH- Terms] “Dosing” [All Fields] AND “All Fields”) or “Dosing Modes” [All Boxes]) AND (“Risk” [Risk Conditions] or “Risk” [All Boxes]) AND PARTAGER [All Fields]] OR Risk Sharing Scheme”[All Fields]) OR “Risk Sharing Agreement” (All Cases) OR “Managed Entry Agreement”[All Fields]) OR “Risk Sharing” [All Fields]) OR “Payment by Result” [All Fields]) OR (Performance [All Fields] AND [All Fields] AND [All Fields] AND (“Risk” [Risk” Risk Conditions] or “Risk” [All Fields]) AND Share [All Fields] AND Agreement [All Fields]] ] OR “price volume agreement” [All Fields] AND ((hasabstract[text] AND “loattrfull text”[sb]) AND English[lang]) Neumann PJ Chambers, JD, Simon F, Meckley LM. Risk-sharing agreements that link drug payment to health outcomes are proving difficult to implement. Health Aff. 2011;30 (12):2329-37. doi:10.1377/hlthaff.2010.1147. Edlin R, Hall P, Wallner K, McCabe C. Risk sharing between payers and suppliers through health technology leasing: an affordable and effective reimbursement strategy for innovative technologies? Health value. 2014;17 (4):438-44. doi:10.1016/j.j.j.j.jval.2014.01.010. Yu JS, Chin L, Oh J, Farias J.
Performance-based risk-sharing agreements for pharmaceuticals in the United States: a systematic verification. J Manag Care Spec Ph. 2017;23 (10):1028-40. If outsourcing is structured as a joint venture for legal reasons, the adequacy of risk-sharing agreements may depend on Sudlow CLM, Counsell CE. Problems with the RISK-sharing system put in place by the UK government to assess MS drugs. Bm. 2003;326 (7385):388-92. doi:10.1136/bmj.326.7385.388. Not surprisingly, the effectiveness and efficiency of health technologies were not considered relevant criteria for price/volume agreements (9% and 5%) respectively. However, the relevance of these criteria for efficiency-based contracts was 96% and 71%, respectively 75% and 96% for efficiency-based contracts. Our results for Spain appear to be consistent with the results of some studies that have recently established that paying bodies in the health sector consider price-volume agreements to be the most common type of contract (77% have experienced these contracts, as Dunlop also found ); Less than half of them had experience with performance contracts – in their text “innovative agreements” – Oncology was also the area where these contracts are applied more often, as we found in our study; the majority of respondents expressed a positive opinion on the potential of this type of agreement to enhance security, manage households and provide additional knowledge about the value of drugs. The Nazareth study  (which includes only one Spanish participant) also highlighted the increasing evolution of the use of these contracts in the five largest EU countries, pointing out that 60% of all contracts signed in the last 20 years were cancer drugs, mainly motivated by their increasing cost per patient.
Respondents also cited the lack of a clear framework for the design, implementation and follow-up of these contracts as a drawback. This study also predicts a significant increase in the number of these types of contracts over the next five years (according to the Spanish survey). As a research topic, it will be interesting to expand the scope of research to other countries and to check whether this knowledge is present in other jurisdictions. This study examined the degree of use of risk-sharing agreements in Spain and the perception of hospital pharmacists as to the relevance of several elements in their implementation.