Table 2.

Definitions and examples of the three types of Market Access Agreements

MAA Category	Commercial Agreement	Payment for Performance Agreement	Coverage with Evidence Development
Contract type	• Discount-based contract	• Permanent risk-shifting agreement (outcomes guarantee/insurance) applied on a per-patient basis	• Provisional agreement until new, clearly specified evidence develops from a cohort of patients
Collection and analysis of patient health outcomes data by the payer	• None	• Per patient	• Cohort of patients
Timeframe of the MAA	• Permanent/not linked to final decision-making	• Permanent/not linked to final decision-making based on new robust evidence	• Temporary/provisional until new evidence allows making a final decision
Underlying concept (payer perspective)	• Reducing pharmaceutical expenditure	• Avoiding inefficient expenditure on treating patients who do not respond to a drug and who cannot be identified ex ante (by permanently linking the payment to drug's performance in individual patients)	• Reducing uncertainty about drug's real-life effectiveness (by linking a final HTA, reimbursement and/or pricing decision to drug's performance in a cohort of patients, during a defined test period)
Examples	• Flat price per patient (regardless of the number of doses administered) • Cost Sharing • Rebate • Discount	• Payment for performance • Pay-back for non performance	• Temporary coverage on a condition that new evidence reduces uncertainty about a pre-specified health outcome: - Real-life effectiveness - Higher efficacy in a pre-specified subpopulation of patients - Long-term effect - Improved patient's adherence - Reduction of use of health care resources (e.g. hospitalization)