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The Pharma Market Access Landscape in the Middle East and North Africa: The Next Ten Years

Introduction

The market access landscape in the Middle East and North Africa is changing rapidly. The region is diverse, comprises many dissimilar countries, and different cultures including languages used in commerce. There are also different approaches to regulating healthcare markets, and concerns about the long-term sustainability of oil revenues shape healthcare markets.

There are other factors that also impact the success of market access in the Middle East and North Africa. These include different market sizes, growing complexity in securing market access, and the importance of private health insurance companies.

To this end, the expansion of private health insurance markets in the Gulf is a significant catalyst for the re-organisation of private sector stakeholders. In the past, payors were generous in their reimbursement of new technologies, but price sensitivity and value-based reimbursement are growing in importance.

Important trends that impact pharma market access in the Middle East and North Africa

This post will explore the changing market access landscape in the Middle East and North Africa region. We’ll look at the important trends and how these will impact access to innovations in the next ten years.

The important trends include:

  • data for reimbursement decision-making;
  • the formalised use of pharmacoeconomics;
  • public-private partnerships;
  • External price referencing; and
  • Innovative contracting.

Data for reimbursement decision-making

Securing market access in the Middle East and North Africa will depend on robust analytics to evaluate the impact of new healthcare technologies in society. Robust analytics establishes a platform to develop pricing insights to discuss with different stakeholders.

Such a platform will integrate international perspectives on pricing approaches and support consultative responses to local pricing dynamics in the Middle East and North African markets. It’s essential that a value framework guide robust analytics aligned price with the clinical value propositions.

We also need systematized and accurate data to improve decision-making on the costs, resource use, and patient outcomes in private and public health facilities. These variables are inputs for undertaking epidemiological studies, pharmacoeconomic analyses, and budget impact evaluations for new technologies entering the market.

Data should integrate patient services in public and private facilities, and inpatient and outpatient treatment settings. Local versus regional care networks are essential for facilitating better budgeting and allocation of funds to reimburse new technologies.

Figure 1: The Pharma Market Access Landscape in the Middle East and North Africa: The Next Ten Years

Pharmacoeconomics in the Middle East and North Africa

The formalised use of pharmacoeconomics in the Middle East and North Africa will enable best available scientific methods to evaluate the economic impact of new technologies.

Pharmacoeconomics guidelines will help improve the general understanding of economic evaluation methods, and it will boost stakeholder confidence. Pharmacoeconomic results improve decision-making.

Applying pharmacoeconomics includes value-based pricing decisions and development of formularies by private health insurance companies. It also involves guiding reimbursement policies set by public payors including the Ministry of Health, Military Institutions, Hospitals and Specialist Treatment Centres.

Most governments revert to decision-making based on the clinical appraisal of a new healthcare technology and its financial impact. A full pharmaocoeconomic evaluation of new healthcare technologies is not required, although some countries have encouraged their submission at the time of regulatory approval.

An essential element of this trend is improving skills to strengthen the commercialisation of innovations. Local market access teams rely on pharmacoeconomic and pricing experts from headquarters based in Europe, North America, and Japan.

The pharmacoeconomic skills improvement involves building stronger capacity among local market access teams and establishing stronger regional presence with competencies across all functional components of market access.

Public – Private Partnerships

Stronger partnerships between private sector stakeholders and better public-private partnerships will improve patient outcomes.

Healthcare markets are complex structures with complex processes that aim to improve patient lives. Many examples are already available on how Ministries of Health, Health Authorities and private sector stakeholders collaborate. It is unclear whether these partnerships result in better outcomes for patients.

Future efforts include transparency in these partnerships and how public and private sector stakeholders improve patient outcomes. Reducing duplicative partnerships that result in wasteful expenditure on activities that do not improve the efficiency of healthcare markets is a priority.

The rapid change in healthcare markets in the Middle East means that stakeholders need the right tools to improve access to new technologies. This change will open exciting opportunities for many companies, but it requires patient-centric and transparent partnerships between stakeholders. 

Figure 2: The Pharma Market Access Landscape in the Middle East and North Africa: The Next Ten Years

External Reference Pricing in the Middle East and North Africa

External reference pricing in the Middle East and North Africa region represents a significant barrier to sustained higher prices. External reference pricing is often used to maintain price harmonisation among neighbouring countries, particularly the GCC countries.

However, often other decision criteria are also used to influence price setting. These include:

  • referencing prices of medicines in the same therapeutic class,
  • prices published by government agencies including health technology assessment agencies, and
  • price of the product in neighbouring countries (price harmonisation).

The number and range of reference countries differ between countries as does the method of comparing new technologies. Saudi Arabia uses a higher number of reference countries, but external reference pricing results in increased complexity and increased time-to-market.

External price referencing systems focus on a price only analysis, irrespective of the country in which it applies. As a result, reimbursement policies are skewed towards the lowest cost option in the therapeutic areas.

Governments seldom consider the value that a new healthcare technology represents for communities and the associated societal benefits. They consider only short-term financial interests. Governments include little in reimbursement policies on the medium-term to long-term value of new healthcare technologies.

Implementing external price referencing systems is isolated with very little involvement from market participants. Sometimes, the external price referencing includes methodological weaknesses. For instance, most countries use the lowest price option in the basket of reference countries and not the mean price, as used in other cases.

Innovative Contracting

Innovative contracting in the Middle East and North Africa is underdeveloped compared to Europe and North America. Stakeholders are aware of the basic forms of innovative contracting, including outcomes-based reimbursement, risk-sharing agreements, and pay-for-performance, among others.

However, this has not materialised into workable agreements to secure the reimbursement of new healthcare technologies. This is because of the absence of thorough value assessments of new healthcare technologies (formal health technology assessments).

Securing market access will also involve developing consistent value stories for all market participants. This includes regulatory agencies, patients, providers, and health technology assessment agencies.

A value story requires a thorough synthesis of real world evidence, key differentiating factors to strengthen product positioning, and an appraisal of market-related risks. These, in combination, impact the introduction of new healthcare technologies and patient access.

Innovative contracting will grow in importance given the rise in cancer epidemiology in the Middle East and North Africa. This, among a high burden of diabetes mellitus, cardiovascular disease, and obesity. Diagnosis improvements and increased life expectancy drive the increase in oncology cases.

Innovative contracting should include:

  • valuing the impact of new technologies on diagnosis rates (medical devices),
  • improving public education and awareness around oncology (and other non-communicable diseases), and
  • an integrated approach with public and private healthcare sectors.

Conclusion

The market access landscape in the Middle East and North Africa is transforming. There are more cost containment policies than before to reduce the total expenditure on pharmaceuticals and medical devices.

Most times, these changes are inefficient (in economic terms) when reimbursement policies overlook the value-added by innovations. As a result, the transition to a value-based pricing approach faces challenges in the years ahead despite opportunities for growth.

Our pharma market access consulting services support our Clients develop market access strategies, payor engagement roadmaps, and value communication strategies in the Middle East and North Africa.

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