Goals and methods of managed entry agreements – can we get what we want?

•Trade-offs and priority setting during the application of MEAs are unavoidable.•Improving cost containment, patient access and reducing uncertainty are key goals supported by MEAs.•Administrative hurdles of implementation shall not limit the application of MEAs. We aimed to examine managed entry agreement (MEA) methods and their relation to nationwide drug reimbursement policy goals in the context of the Hungarian health care system. First, a targeted literature review was performed that identified the most relevant MEA methods and drug reimbursement goals. Then, by using the findings of the review, a survey was developed: the first part of the survey aimed to ensure that interviewees have similar understanding of different types of MEAs and related policy goals; in the second part the interviewees were asked to prioritize drug reimbursement goals and indicate their perception about the impact of MEA techniques on the reimbursement policy goals. Three groups of MEA techniques were identified: cap type, clawback type and rebates or free treatment doses. Six policy goals were identified: cost containment, reduction of uncertainty of effectiveness, sustainable finance, patient access improvement, cost-effectiveness improvement, handling administrative burden. None of the MEA techniques showed clear advantage over all others. Cost containment, improvement of patient access and reduction of uncertainty around effectiveness were ranked as most important drug reimbursement goals. Cap type agreements were deemed to uniformly support the policy goals of cost containment and sustainable financing. Clawback type agreements strongly support cost containment policies. Rebates and free treatment dose(s) methods had positive impact on four policy goals. The implementation of managed entry agreements shall be considered and motivated by pre-defined drug reimbursement policy goals. During the application of MEAs, setting priorities and making trade-offs between different policy goals are inevitable.