| Summary: | Concerns about affordable access to medicines reflect the emergence of new, high-priced medicines, as well as expectations regarding the cost of precision therapies coming to market. Compared with a decade ago, novel medicines are subject to longer delays between global launch and market access, even in wealthier countries. Various paths forward offer potential policy solutions to address problems with access to high-priced pharmaceuticals. This technical report considers four categories of policies - demand pooling, formal tiered pricing, risk-sharing agreements and policies to harness competition - with potential to ameliorate issues in ensuring timely, affordable and equitable access to effective medicines in the WHO European Region. Each approach offers the potential to address a different dimension of the affordability problem. The most promising strategies to tackle affordability of high-priced medicines are likely to entail a combination approach - for example, a test pilot of a single-buyer agreement using a combination of managed-entry agreements and tiered pricing for agreement signatories under an agreed formula. To facilitate policy development, stakeholder commitment to three underlying principles - solidarity, transparency and sustainability - is essential
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