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The level of implementation of risk-sharing agreements in Spain has been high, with 90% of respondents saying that they currently have such a contract with a pharmaceutical company and that they want to renew it or sign new ones. Respondents noted that the most frequent risk-sharing agreements take the form of price volume. Oncology, neurology, dermatology and infectious diseases were the main medical specialties that used these agreements. Toumi M. ZardJ, Duvillard R, Jonmi C. Innovative drugs and market access agreements. Pharmaceutical records. 2013;71 (5):302-25. Zaric GS, Zhang H, Mahjoub R. Modling Risk Sharing Agreements and Patient Access Systems. In: Zaric G, editor. Business research and health policy.

International series in operations Research and Management Science, 190. New York: Springer; 2013. 295-310. One of the main challenges for RSAs is to determine how these types of agreements can be structured. Suppliers and manufacturers need to be aware of the common goals they are striving to achieve – and whether a financial or results-based model is preferable. In the case of results-based agreements, it is important to ensure that the measures followed are objective, clearly defined, reproducible and difficult to manipulate. In addition, consideration should be given to how results are recorded. The extent to which current monitoring mechanisms can be used will help minimize objections to progress. Launois R, Ethgen O. Risk-Sharing Agreements: Choice of study design and assessment criteria. Ann Pharm Fr.

2013;71(5):346-57. Once the objectives of the RSA are clear, manufacturers must determine the best contract structure. The structuring possibilities of the ASRs vary depending on the level of risk assumed by each party. The risk proposed in the agreement may be upside down, down or in a combination. The most common agreements are financial agreements and results-based agreements. The therapy is aimed at patients who have the potential to benefit (preventing risks in patients who would not benefit) Although ARAs are at risk, they also create opportunities for manufacturers. One of the greatest opportunities is the ability to develop a deeper relationship with a supplier. Through discussions, manufacturers have the opportunity to gain insight into the supplier`s processes and objectives and to create greater direction. This knowledge can lead to a stronger working relationship, which will be useful in the future. The participants were members of the Spanish Society of Hospital Pharmacy – Sociedad Espaéola de Farmacia Hospitalaria – (professional specialists involved in purchasing decisions regarding the acceptance of risk-sharing contracts).

They were asked about their opinions and personal experience with risk-sharing contracts. The survey was web-based with closed and semi-closed questions, multiple-choice and scale. The questions related to the degree to which the different terms of risk-sharing contracts (price volume, payment effect and efficiency payment) were implemented and their perception of the inbreeding aspects (medical domains, management variables and regulatory frameworks) that influence the adoption of these contracts. The questionnaire had 32 questions. The questionnaire design process had several phases, including the revision of draft versions by four experts from the hospital`s pharmacy, who proposed changes on several issues to make them more understandable until the final version was clear enough to be sent to all potential respondents (the questionnaire is available on request).

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