Rethinking access to medicines in Lithuania (Guest blog)
Lithuania is on the cusp of a major overhaul of its Health Technology Assessment (HTA) system. The changes, due to begin in July, reflect wider shifts in how quickly patients in the Baltic state will access innovative therapies in the years ahead.
Authorities are exploring new approaches to evaluating and paying for medicines, seeking to learn from the experiences of other European countries and adapt them to the Lithuanian health system. This includes an increasing openness to collecting real-world patient outcomes and incorporating this data into reimbursement decisions.
Change is overdue. Lithuania has, for years, lagged the EU average – and its near neighbours – in providing timely access to modern medicines. To help catalyse change and improve links between Lithuanian decision-makers and HTA authorities elsewhere in Europe, EFPIA worked with patient groups and the health ministry to host a high-level international conference on ‘Future-Proofing Healthcare Systems’.
‘The conference focused on improving health system performance and the role of Managed Entry Agreements, but it was a little different to a typical event on of this kind,’ said Šarūnas Narbutas, President of the Lithuanian Cancer Patient Coalition. ‘It was held in the Lithuanian Parliament, with an address from the Ministry for Health, and heard from a wide range of stakeholders from other EU Member States.’
Large international conferences on health policy, market access and HTA tend to focus on larger Western European countries, but this event looked at how examples from across Europe could be applied in a Lithuanian setting. Speakers from Denmark, Finland, Sweden and the UK, complemented contributions from industry and hospital management. Around 200 attendees took part.
For his part, Mr Narbutas, viewed it as an important landmark in the evolution of Lithuanian cancer care. A lawyer by profession, he is also a cancer patient who has lived with chronic myelogenous leukaemia (CML) for more than 12 years. He has successfully campaigned for the introduction of modern, effective treatments for all CML patients in Lithuania.
In oncology, Lithuania has already seen some progress in enhancing access to medicines with several new medicines approved for reimbursement in the past year. Patient groups can play a role in communicating the burden of disease and unmet need.
‘We are preparing to work within the new HTA model and will be in a position to submit our own evidence based, for example, on surveys of patients about quality of life, side effects of treatment and so on,’ he said. ‘We can leave clinical questions to healthcare professionals but we can add a lot of value by describing the challenges we face.’
Managed Entry Agreements include well-established ways to bring medicines to patients. Some include discounts, delayed payments, the provision of diagnostic tests, and support for medical education. ‘But it’s about more than discounts – some countries are using real-world outcomes data to measure the performance of new therapies, and then paying when medicines deliver results for patients,’ Mr Narbutas said. ‘Pricing data is confidential but other elements of these agreements can be shared. We are pleased to see growing cooperation between HTA agencies in Lithuania, Sweden, Scotland and Poland on how real-world evidence can influence reimbursement.’
This will help patients and policymakers to benchmark Lithuania against European peers and to learn more about how Managed Entry Agreements works, he said. ‘The introduction of a new HTA system brings new possibilities and an open-mindedness about how we can facilitate access to innovation.’
Mr Narbutas said that while decision-makers have historical focused only on securing the lowest price possible, there is growing interest in how to get access more quickly, conditional reimbursement and supporting disease registries for monitoring real-world patient outcomes. ‘There are myriad of opportunities that had never been discussed in great detail here,’ he said. ‘Now we are entering a new era.’