OBJECTIVES: The European Federation of Pharmaceutical Industries and Associations (EFPIA) has published its Waiting to Access Innovative Therapies (W.A.I.T.) Indicator survey with data covering the last decade. Recent surveys show that the availability of medicines has been decreasing over time in four Nordic countries. Furthermore, there are marked differences between the countries regarding median time to reimbursement. This study aimed to increase understanding on the factors impacting patient access in the Nordics.

METHODS: A targeted literature review was conducted on guidelines by the Nordic health technology assessment (HTA) bodies, local reports on patient access to medicines, Nordic registries studies, and grey literature. The chosen time period was 2015 until 2024. The review was used to map factors partially driving the trends over time and the differences between Sweden, Norway, Denmark and Finland.

RESULTS: The review showed several factors impact patient access, such as the differences in the national reimbursement systems, use of individual reimbursement pathways, type of drugs receiving EMA approval over time, and increasing emergence of ultra rare indications. For example, decision-making without cost-utility analysis in Denmark before 2021 could explain the higher availability and shorter median time to reimbursement in the country. Also, over time, a shift has emerged from blockbuster drugs to targeted medicines designed for smaller patient populations, e.g. orphan drugs and advanced therapy medicinal products (ATMPs). This may affect market prioritization (smaller markets are prioritized to a lesser extent), but can also lead to uptake outside of the national reimbursement system.

CONCLUSIONS: Country-specific factors and global trends can partly explain the differences observed in EFPIA’s W.A.I.T. numbers. In the future, the European Joint Clinical Assessment, as well as the recently widened Nordic HTA collaboration including price negotiations may shape the access to medicines in the Nordics.