A number of approaches were discussed to fund new drugs evaluated that would overcome current barriers. This includes developing new models to optimize the entry of new drugs under management, starting 36 months before the likely approval of the EMA by horizon scanning activities. In addition, the actual role and value of new drugs will be further evaluated to ensure that funding is focused on the most popular new drugs in all populations or populations, as well as greater patient involvement in key areas. This is closely monitored. In this context, we will probably see the growth of MEAs to help finance new drugs, although there are concerns about these drugs, including the persistence of confidential rebates. This should lead to intensified discussions on whether these reductions should be continued in public health systems. There will also be clearer future objectives for all proposed MEEs and more monitoring of their results, including possible administrative burdens, to guide future programmes, and this will be continued in future research projects. The importance of early access to medicines, even when it is not (yet) possible to make a final decision on reimbursement, in particular because the effectiveness (in terms of costs) is still unknown or the budgetary impact is uncertain, has led to a wider use of these MEAs. For example, in 2018, almost 30% of the 2018 budget was spent on drugs under an AEE. This popularity is also accompanied by criticism of the confidentiality of these agreements. Preparatory documents for the new law note that the confidentiality of MMAs is problematic because it prevents the Chamber of Deputies from taking control of the Belgian government and the effectiveness of the health budget. The new law aims to improve the transparency of these MEAs. It is difficult to know to what extent performance-based EREs have been successful to date.
Few countries have formally assessed their experience. The confidentiality of agreements remains an obstacle to independent evaluation and little public evidence is availab evidence. However, information from expert interviews and previous studies shows that reports on the Evidence Development (EDC) agreements have so far had a poor record in reducing uncertainty about drug performance.