A rapidly changing global medicines environment: How adaptable are funding decision-making systems?

•Extra-ordinary drug price increases put enormous pressure on drug funding agencies.•Through interviews with funding agencies challenges in priority setting are described.•Systems' characteristics facilitating/hindering to adapt to changes are outlined.•Structured communication on financial limits and priority setting is needed.

BackgroundWith the launch of very highly priced therapies and sudden price increases of generics, pressures on health systems have drastically increased.ObjectivesWe aimed to elicit opinions of key decision makers responsible for national assessment and funding decisions on their experiences to adapt to these new realities.Methods/settingThrough interviews with decision makers of pharmaceutical assessment and/or funding agencies, we describe the challenges systems are currently facing, systems' responses and systems' characteristics facilitating or hindering responses to changes and overarching topics for the future.ResultsAmong the most common challenges are increased funding pressures, increased uncertainty and lack of transparency in decision-making. Systems' responses include utilization management, changing of assessment processes, stakeholder engagement and a focus on outcomes and on coordinated negotiations. Integrated delivery systems, fixed health care budgets and geographic and historical characteristics facilitate or sometimes hinder responses to change. Future policy emphasis lays on expanding data structures, managing the exit of drugs funded early, and implementing processes for communications with patients and the public.ConclusionsGoing forward emphasis has to be given to structured communications with all stakeholders with a specific emphasis on the broader public and patients about financial limits and priority setting in health care.