4.F. Round table: Fair processes and fair pricing: examining deliberative processes and the role of HTA for UHC
Authors:   Organised by: EUPHA Health technology assessment section, HTAi,   Chair persons: Elena Petelos - Greece, Carlo Favaretti – EUPHA-HTA
Published: October 2020

Achieving Universal Health Coverage (UHC) represents a global commitment and is part of the Sustainable Development Goals. The UHC Political Declaration states 'high prices for some health products, and inequitable access to such products within and among countries, as well as financial hardships associated with high prices of health products continue to impede progress towards achieving UHC'.

The rapid rise and cost of new therapies has led to polarised discussions on what constitutes a fair price, whether R&D costs justify the prices, and whether the current intellectual property protection framework is appropriate for global public health goods.

In this light, we are progressively moving from value-based pricing to fair and sustainable pricing; fair pricing carries the notion of just proportion of value to all involved parties. To render this possible, all relevant stakeholders need to be involved in transparent processes characterized by democratic representation, with communication and information exchanges safeguarded to establish what is fair and what is sustainable.

HTA can help towards this as it is a tool to inform pricing and planning decisions, potential investment or disinvestment decisions, decisions on cross-country collaboration for price negotiation, and state decisions to invest in R&D or in manufacturing, or to negotiate supply. HTA allows capturing the needs and preferences of users of the health system and carries the potential to determine societal value in relation to public reimbursement. Governance mechanisms allowing HTA to be organised as a continuous evidence-informed deliberative process could function as the necessary exchange platform for all relevant stakeholders.

For an interdisciplinary examination of deliberation in HTA, and to establish the key attributes the notion of fairness can carry, it is important to bring together different perspectives. Evidence-informed decision-making, and processes which ensure transparency and legitimacy, may require changes in evidence generation, but, also, in the legislative, regulatory and pricing frameworks. What is already feasible will be discussed, e.g., cases where information exchange and centralised procurement resulted in improved negotiation, along with how sound governance structures could support stakeholder representation and involvement.

The principal objectives of the workshop are 1) to explore notions of fairness and approaches deemed feasible and relevant, and 2) to identify, through multistakeholder dialogue, key attributes for ensuring legitimate decision-making, and UHC incl. through fair pricing. Academia, HTA agencies, incl. from Low- and Middle-Income Countries (LMICs), the World Health Organization, payers, and patients are represented in the panel. Each speaker will make a 12-min presentation, followed by a 30-min discussion between panel and audience. An interactive element will allow the audience to respond to Yes/No statements and submit questions.

Key messages

Deliberative processes can contribute to establish multi-stakeholder agreement on what constitutes fair pricing. HTA as a deliberative process can critically contribute towards legitimate decision-making.