Outcome-Based Payment (OBP) schemes are commercial arrangements where a medicine’s price is linked to the outcomes achieved for patients receiving the medicine in real-world clinical practice.

OBP encompasses a range of different possible models which vary in characteristics including how financial risk is shared between a company and the payer, and whether the link is dependent on population-level or individual patient outcomes.

These payment schemes can range, from cost/risk sharing to payment-by-results: paying by performance or guaranteeing outcomes. Some have been structured around evidence development. Access to a drug is initially provided on the condition that further population-level evidence is gathered.

OBP schemes are already in use. For example, in November 2017, NHS England announced it had agreed “pay by cure” deals for medicines to treat Hepatitis C and Multiple Sclerosis, which it badged as the latest in “a series of outcome-based payment arrangements”. There are also numerous examples of OBP schemes being used globally in countries including Australia, Italy and the Netherlands.

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