Multi-Year Multi-Indication Agreements for Supporting Patient Access to Oncology Medicines with Multiple Indications: An Experimental Approach or Here to Stay?

Over the past decade, an increasing number of oncology medicines with indications for multiple cancer types have been delivering benefits to patients. To ensure these products reach patients, pricing and reimbursement systems have had to adapt to address the value assessment, time-to-access, affordability, and budget uncertainty challenges this creates. Multi-year multi-indication (MYMI) agreements are made between payers and manufacturers and aim to ensure that patients have access to effective treatments for multiple conditions over time; this includes future indications of the treatment. MYMI agreements were first introduced as a solution in several European countries in 2017, offering a range of potential benefits. MYMI agreements have since demonstrated evidence of success in mitigating many of the challenges associated with assessing and reimbursing multi-indication products, time-to-patient access, and budget impact. The purpose of this article is to discuss the recent progress made with MYMI implementation across countries and provide a view on whether it is delivering for patients, healthcare systems, and innovators. We find that MYMI is not a one-size-fits-all solution but a model that needs to be adapted to the unique needs and characteristics of different healthcare systems. The intended benefits of MYMI to patients (speed and breadth of access to new indications) appear to have been realised in practice in some countries but not all. However, the administrative burden associated with MYMI implementation in some countries risks jeopardising the intended efficiency benefits. Payers and policymakers can also benefit from improved budget predictability and sustainability.