Most-Favored-Nation Benchmarking Versus Value-Based Contracting: Institutional Fit of Pharmaceutical Pricing Tools in the United States, Canada, and the United Kingdom.
Background: Soaring drug prices pose a significant obstacle to affordable and equitable access to medicines in high-income healthcare systems. This study compares two leading reform tool families, Most Favored Nation (MFN)/international reference pricing (IRP) and value-based contracting (VBC), acro...
| Publicado en: | Health Services Insights Vol. 19; pp. 1 - 13 |
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| Autores principales: | , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Sage Publications Inc.
5/19/2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=193893606&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 193893606 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 11786329 B10H jtl: Health Services Insights issn: 11786329 maglogo: Y pubinfo: dt: 5/19/2026 vid: 19 pid: 344 pub: Sage Publications Inc. place: Thousand Oaks, California artinfo: ui: 193893606 193893606 193893606 10.1177/11786329261448992 193893606 ppf: 1 ppct: 12 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Most-Favored-Nation Benchmarking Versus Value-Based Contracting: Institutional Fit of Pharmaceutical Pricing Tools in the United States, Canada, and the United Kingdom. aug: au: Adegoke, Kola Durojaye, Olajide Alfred Adegoke, Abimbola Adegoke, Adeyinka affil: Department of Health and Biomedical Sciences, College of Health Professions, University of Texas Rio Grande Valley, Edinburg, TX, USA sug: subj: Health Care Reform United States Health Care Reform Canada Health Care Reform United Kingdom Prospective Payment System Value-Based Health Care Reimbursement, Incentive Health Services Accessibility Policy Making Pharmacy Service United States Canada United Kingdom Comparative Studies Policy Studies Conceptual Framework Models, Theoretical Costs and Cost Analysis United States Centers for Medicare and Medicaid Services Negotiation Reimbursement Mechanisms Implementation Science ab: Background: Soaring drug prices pose a significant obstacle to affordable and equitable access to medicines in high-income healthcare systems. This study compares two leading reform tool families, Most Favored Nation (MFN)/international reference pricing (IRP) and value-based contracting (VBC), across the United States, Canada, and the United Kingdom, with attention to cost containment, value-linked incentive design, equity of access, and implementation feasibility. U.S. policy developments (CMS Innovation Center's GENEROUS, GLOBE, and GUARD models) extend international benchmark-based design options beyond the 2020 MFN rule. Methods: Guided by institutional and governance theories, we conducted a structured comparative policy analysis using a four-dimensional trade-off matrix. Cases from the United States, Canada, and the United Kingdom were selected using a most-different-systems design. Documents from 2007 to 2025 were coded for cost containment, value-linked incentive design, equity, and implementation feasibility. To reduce subjectivity, scores were assigned using prespecified rubric anchors, conservative scoring rules for borderline cases, and a sensitivity check of adjacent-score judgments. Design-stage U.S. benchmark-based model materials assessed on March 5, 2026, were incorporated descriptively and not considered as outcome evidence. Results: The United Kingdom model, centered on the National Institute for Health and Care Excellence (UK NICE) and the Voluntary Scheme for Branded Medicines Pricing, Access and Growth (VPAG), was most consistently aligned across all four dimensions (design-feature alignment). Canada's Patented Medicine Prices Review Board (PMPRB) supports affordability and baseline access, with implementation variation across provinces and more limited adoption of outcomes-based contracting. U.S. MFN/IRP initiatives and VBC pilots show lower alignment on equity and feasibility in a multi-payer environment characterized by contested authority and variable data/contracting capacity. Emerging CMS Innovation Center proposals (GENEROUS, GLOBE, GUARD) indicate continued federal interest in benchmark-based designs, but empirical impacts remain to be evaluated. Conclusions: MFN/IRP anchoring and VBC are implementation-intensive tools whose performance depends on institutional fit. A hybrid approach, using international benchmarks as inputs for negotiations and expanding value-linked agreements where measurement and governance prerequisites are met, may offer a more feasible U.S. pathway. This study provides a repeatable framework for assessing drug pricing reforms and illustrates how institutional alignment conditions the implementability of tools. Design-feature scores reflect policy design and governance capacity, not realized outcomes. Plain Language Summary: Prescription medication prices are often high, making it difficult for people to access the medicines they need. This study examines how three countries, Canada, the United Kingdom, and the United States, attempt to control prices while supporting fair access and workable implementation. We focus on two main approaches: using international price benchmarks to inform pricing (international reference pricing/MFN-type designs) and paying based on a drug's clinical value or outcomes (value-based care/value-based contracting). We found that countries differ mainly because their health systems are organized differently. The United Kingdom's centralized structure supports more consistent policy implementation, while the United States' multi-payer structure creates greater legal, administrative, and data challenges. Canada shows strong price regulation and baseline access, but policies vary across provinces and outcomes-based contracting is less common. Newly assessed March 5, 2026, U.S. proposals (GENEROUS, GLOBE, GUARD) suggest continued federal interest in international benchmark-based approaches, but these are recent and do not yet have outcome evidence. We suggest a combined approach in the United States: use international benchmarks to strengthen negotiations and expand value-linked contracts only where measurement and coordination are feasible. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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