Over the past 20 years, there have been significant advances in the cancer treatment landscape, leading to improvements in prognosis and overall patient survival. Combination therapies (therapies made up of two or more “constituents”) have contributed significantly to such advances and, in many cases, are more effective and offer prolonged overall and/or progression-free survival compared to monotherapies. Despite these benefits, ensuring patient access to combination therapies in Europe has proved difficult. In particular, free-dose combinations of on-patent therapies, especially when constituents are marketed by different manufacturers and have multiple indications, face unique access challenges within the oncology space.

Although multiple stakeholder groups have debated the problem and the potential solutions, there is still limited awareness about the situation and progress in addressing this problem has been slow. Consequently, access to on-patent oncology combinations has lagged behind access to oncology medicines in general. If no further action is taken, the limitations on treatment availability and consequences for patients are expected to worsen especially as an increasing number of oncology combination therapies are due to launch over the next five years. This is a significant issue with approximately one in five oncology medicine expected to be a combination therapy (compared to approximately one in ten over the past five years). If this challenge persists, manufacturers may be disincentivised to invest in the development of combination therapies, limiting the potential of future research.

This analysis aims to describe the challenges affecting patient access to oncology combination therapies across various European markets (Belgium, England, France, Germany, Ireland, Poland, Spain, and Sweden), with a specific focus on the value assessment, pricing negotiation and reimbursement conditions. Progress on the most prominent solutions is discussed, along with considerations regarding their implementation.