There are a few publications on performance agreements that contain at least information about covered drugs. In its soul and conscience, there is only one publication that assesses the impact and impact of an agreement in Spain . Regarding health outcomes as the basis for each type of risk-sharing agreement, 60% of respondents indicated that overall survival was considered the most influential parameter for signing the contract, followed by progression-free survival (22% of respondents) and quality of life (23% of respondents); Other effects, such as better patient monitoring, therapeutic response and improved access to medication, were mentioned by 18% of participants. All of these factors lead to a cost risk in terms of payment too much for desired health benefits or not too much benefit for costs or beyond budget than expected. The payer believes that at the time of the reimbursement decision, there is also a lack of clarity as to the actual health generated by a drug and the impact of access on the overall budget. There are some indications from clinical studies and economic health assessments. However, a complete reduction in risk requires several costly long-term studies that payers and manufacturers are resistant to funding. Garattini L, Curto A, van de Vooren K. Italian drug risk-sharing agreement: are they equal? Eur J Health Econ. 2015;16:1-3. If outsourcing is structured as a joint venture for legal reasons, the adequacy of risk-sharing agreements may depend on it: a total of 80 participants responded to the questionnaire. The sample included all Spanish regions, with the exception of the Balearic Islands. The number of responses in each region reflects somewhat the number of hospitals (i.e.
large regions with multiple hospitals generated more responses than smaller regions); Therefore, the representativeness of the sample was sufficient. Nearly 90% of respondents worked in a hospital pharmacy, and about 12% worked directly in the administrative departments of the regional health agency. The distribution of foreign exchange risks generally includes a legally binding price adjustment clause, with the base price adjusted when the exchange rate is higher than a neutral band or a given area.