Funding Multi-indication Medicines: A Scoping Review of Health Technology Assessment and Reimbursement Frameworks

Abstract

Background

Medicines with multiple indications pose efficiency problems for health technology assessment (HTA). Evaluating indications separately may result in years of duplicative evaluation work and ultimately delay patient access. The price of these medicines is also difficult to determine because the value may vary between the different indications.

Objectives

A scoping review was conducted to identify HTA and reimbursement frameworks for evaluating and pricing multi-indication medicines for reimbursement decisions and to explore whether there are elements in these frameworks that would have utility if implemented in jurisdictions with well-established HTA systems.

Methods

PubMed, Embase and Scopus were systematically searched and a targeted search of HTA agency websites was conducted in September 2025. Documents were included in the review if they discussed HTA and reimbursement frameworks concerning multi-indication medicines in high-income countries.

Results

Sixteen frameworks were identified, describing four main approaches: policy (3), pricing (6), HTA evaluation methods (4) and decision-making (3). Policy approaches included implementing conditional listing processes and streamlining the evaluation of multi-indication medicines. Pricing frameworks including indication-based pricing frameworks and volume-based agreements were reported most frequently.

Conclusions

While pricing frameworks are commonly used in high-income countries, they do not help reduce duplication of effort in the evaluation and appraisal of these medicines. Policy change allowing for the streamlined incremental evaluation of each new indication may be helpful, although the methodological characteristics of a streamlined HTA have yet to be defined. Subscription-based approaches to purchasing medicines represent another option. Stakeholder engagement is needed to determine the merit and feasibility of different approaches.