Adamski J, Godman B, Ofierska-Sujkowska G, Osiska B, Herholz H, Wendykowska K, Laius O, Jan S, Sermet C, Zara C, Kalaba M, Gustafsson, Garuoliene K, Haycox A, Garattini S, Gustafsson LL. Risk-sharing agreements for medicines: potential considerations and recommendations for European payers. BMC Health Serv Res. 2010;10:153. Health insurers are increasingly using risk-sharing agreements with drug manufacturers to address uncertainties about the cost and effectiveness of new drugs. There are several risk-sharing models, including those based on sales volume, achieving clinical thresholds and achieving cost-benefit thresholds. The purpose of this article is to compare two risk-sharing agreements and to examine the conditions under which each is preferable from the point of view of the payer and the manufacturer. Risk-sharing agreements are rare in outsourcing operations. When one party has physical control over the means of performance, the other party is prevented from exercising control. The other party is thus prevented from acting to stop the loss.
In addition, outsourcing operations generally involve repetitive business processes, which are well-tested, daily, well understood and not inherently risky. However, outsourcing, which includes a certain joint venture structure, may include such risk-sharing agreements. Zaric GS, Zhang H, Mahjoub R. Modeling Risk Sharing Agreements and Patient Access Systems. In: Zaric G, editor. Business research and health policy. International series in operations Research and Management Science, 190. New York: Springer; 2013. 295-310. In Spain, empirical studies on risk-sharing agreements are rare. We found only one publication  assessing the results of the risk-sharing contract for geitinib in Catalonia; other studies conducted by Rojas and Antonanzas  have focused on the perception by several interested parties in Spain of the adequacy of these contracts as a management instrument.
They conducted in-depth interviews with 14 medical specialists (hospital pharmacists, laboratory directors and oncologists) to understand the legal and practical aspects of different types of agreements and the prospects for their future use. This study found that most of the contracts were signed at the local level between hospitals and pharmaceutical companies. The hospital pharmacists are committed to managing these contracts; Given the limitations of the sample size of this empirical work, further research is needed to better understand their pros and cons and to confirm some of the results obtained so far in the literature. Walker S, Sculpher M, Claxton K, Palmer S. Coverage with evidence, only in research, risk sharing or patient access patterns? A framework for hedging decisions. Health value. 2012;15(3):570–9. Respondents were aware that widespread adoption of risk-sharing agreements would lead to more complex protocols and clinical patient management (55%). However, they were not sure (64%) whether, in the future, these contracts would make clinical performance more dependent on other services (such as the genetic laboratory, the records department and the hospital pharmacy).
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