Legitimacy of medicines funding in the era of accelerated access

21 September 2017

Objectives: In recent years, numerous frameworks have been developed to enhance the legitimacy of health technology assessment processes. Despite efforts to implement these “legitimacy frameworks”, medicines funding decisions can still be perceived as lacking in legitimacy. We therefore sought to examine stakeholder views on factors that they think should be considered when making decisions about the funding of high-cost breast cancer therapies, focusing on those that are not included in current frameworks and processes. Methods: We analyzed published discourse on the funding of high-cost breast-cancer therapies. Relevant materials were identified by searching the databases Google, Google Scholar and Factiva in August 2014 and July 2016 and these were analyzed thematically. Results: We analyzed 50 published materials and found that stakeholders, for the most part, want to be able to access medicines more quickly and at the same time as other patients and for decision-makers to be more flexible with regards to evidence requirements and to use a wider range of criteria when evaluating therapies. Many also advocated for existing process to be accelerated or bypassed in order to improve access to therapies. Conclusions: Our results illustrate that a stakeholder-derived conceptualization of legitimacy emphasizes principles of accelerated access, and is not fully accounted for by existing frameworks and processes aimed at promoting legitimacy. However, further research examining the ethical, political and clinical implications of the stakeholder claims raised here is needed before firm policy recommendations can be made. Keywords pharmaceutical funding decisions; resource allocation; stakeholder engagement; breast cancer; accelerated access