Innovative Models for High-Cost Medicines: A Comparative Analysis Across the U.S., Indonesia, and Asia

Abstract

Rising expenditures on high-cost, high-value medicines—such as direct-acting antivirals (DAAs), cancer immunotherapies, and biologics—pose a major threat to the financial sustainability of healthcare systems worldwide. Traditional procurement models, based on unit pricing, often restrict access for patients in need. This paper presents a comparative analysis of innovative financing mechanisms designed to enhance affordability and equity. In the United States, subscription-based models (“Netflix models”) for Hepatitis C DAAs have expanded access while capping budget exposure. Indonesia has relied on bulk procurement through its e-catalogue, formulary restrictions, and selective use of compulsory licensing to drive prices down, though access to novel therapies remains constrained. Japan and South Korea have institutionalized health technology assessment (HTA), dynamic price revision, and managed entry agreements to align prices with value. Thailand has employed government-use licenses to enable generic access to high-cost HIV and cancer medicines. India has combined compulsory licensing, aggressive price caps, and extensive production of generics and biosimilars to ensure affordability. China has leveraged national reimbursement drug list (NRDL) negotiations and volume-based procurement to achieve price reductions averaging 50–65% for new drugs. Across these cases, subscription models, advance purchase commitments, and regulatory strategies reflect different trade-offs between equity, innovation incentives, and fiscal sustainability. The findings highlight that while no single approach is universally optimal, each offers valuable lessons. Proactive financing models can unlock broad access where the health impact is clear, while strong regulatory negotiation can secure rapid affordability at scale. Together, these approaches expand the global policy toolkit for ensuring timely and equitable access to life-saving therapies without compromising the viability of health systems.