High-cost technologies, including medications, are partially covered by insurers. Consequently, many patients do not receive their treatments on time and are forced to legal proceedings against their insurance. Additionally, the treating institution assumes a high financial risk when the patient cannot afford the high cost prescription.
In August 2024, the Office of Value and HTA began operations with a team consisting of a nurse, a engineer, a physician, a lawyer and a pharmacist. The objectives were:
• Generate value for high-cost technologies requiring patients, managing the prescription creating timely access.
• Facilitate transparent communication between all stakeholders.
• Achieve financial coverage through cost-effectiveness analysis of prescriptions.
• Reduce financial risk for the provider institution.
The office receives cases from many clinical services with the need to receive high-cost technology therapy. The methodology considers a patient centered analysis from the medical,cost-effectiveness an social perspective, including all the stakeholders involved in the care cycle. A journey is considered for each case: Medical prescription, review by a peer committee, a complete clinical report including the prescription support, international guidelines references, expected treatment duration, prescription period for which financial coverage is requested, and the monitoring plan to evaluate effectiveness. Then, the case is transferred to the budgeting department for a financial assessment and subsequently referred to the Value&HTA Office. There, another comprehensive evaluation is conducted including a cost-effectiveness analysis, review of the patient’s insurance and coverage options. The Office presents the case to the insurer, who, after a period, issues a formal resolution defining the terms and financial coverage duration. Typically, approval is granted for an initial period while clinical outcomes are monitored; coverage may later be extended or discontinued depending on patient results. We ask physicians to measure PROMS to track progress over time and transparently justify the therapy continuation.
The initiative has increased the value delivered to all participants in the care cycle: patients/families have timely access to therapy, physicians can prescribe they consider most appropriate, institutions reduce financial risks, and insurers reduce uncertainty, the number of lawsuits, and improve beneficiary satisfaction.
During 2025, the HTA Office was launched as a pilot initiative, evaluating a total of 54 patients requiring high-cost technologies, including medications and devices. Of these, 34 patients were specifically assessed for high-cost medications. The initiative achieved an estimated €3,000,000 in medication-related financial risk mitigation, primarily within pharmaceutical technologies.
Recently a survey was implemented to evaluate patient-reported experience of care and the quality-of-life perception. The overall Patient Value Score reached 93/100. All respondents (100%) reported improvement in their health condition and quality of life after receiving the medication. Timely access to treatment scored 89/100, while overall care experience scored 91/100. Patients also reported feeling accompanied and informed throughout the process, highlighting the perceived transparency and coordination of the initiative.
These results demonstrate not only economic impact but measurable improvements in patient-relevant outcomes. By integrating outcome measurement, cost-effectiveness analysis, and financial coordination into one structured pathway, the Office creates value for patients, physicians, insurers, and the institution, reducing uncertainty while improving access and sustainability of high-cost care.