Any market access team that has worked across Latin America knows this scenario: the global value story arrives, gets translated, and deflates in the first meeting with the local payer. The framework was solid. The argument for "incremental value over comparator" was well written. But the technical director of the EPS, the SUS pharmacy coordination, or the country reimbursement committee asked three questions the global deck did not anticipate, and the conversation ended there.

This article is the step-by-step guide for building a value story specifically for Latin American payers in 2026. It does not replace the global framework. It grounds it.

1. Start with the payer, not with the product

The most common mistake in imported value stories: starting with the product's mechanism of action, moving to pivotal clinical data, and closing with an ICER and a budget impact analysis.

The major industry frameworks (Deloitte, ZS, AMCP dossiers) converge on a principle that applies in Latin America as much as anywhere else: start with what matters to the access stakeholder and work backwards to demonstrate value.

For the Latin American payer, that means understanding first:

Who actually makes the decision? In Colombia, the EPS or ADRES? In Brazil, CONITEC, ANS, or the state-level committee? In Mexico, CSG or specifically IMSS?
What is their budget and fiscal horizon? Most are annual and politically constrained.
What is their preferred unit of measure? CONITEC historically prefers cost per life year gained or per event avoided over cost per QALY. Other payers think in terms of total cost per patient treated, not cost per QALY.

If your value story does not answer these three questions before introducing the product, it started off badly.

2. Build the disease story before the product story

The second step is the disease story: the narrative about the problem the drug solves, from the local payer's perspective.

Core elements:

Local disease burden: prevalence and incidence with country-specific data, not global extrapolations. For Colombia, sources like SISPRO, Cuenta de Alto Costo, or IETS studies. For Brazil, DataSUS and Fiocruz publications. For Mexico, data from INSP or ENSANUT.
Current treatment pathway: what patients actually receive in the real system (not in international guidelines), what is covered, what it consumes in resources.
Clinical and economic gaps in the current pathway: treatment failure, adverse events, avoidable hospitalizations, treatment dropout, indirect costs.
Equity and access: an argument that carries more weight in Latin America than in developed markets, especially for diseases affecting vulnerable or rural populations.

The locally-grounded disease story is what opens the door. The payer needs to recognize their own system in the problem before they evaluate the solution.

3. Define the value driver mapping for the local payer

Once the disease story is established, the next step is mapping which product attributes translate into value for the specific payer.

In Latin America, the value drivers that carry the most weight are consistently:

Reduction in direct medical costs (hospitalizations, emergency visits, procedures).
Reduction in resource use (bed-days, chemotherapy sessions, consultations).
Survival and functional improvement with defensible clinical evidence.
Possibility of outpatient management (eases hospital pressure).
Compatibility with the existing system infrastructure.

The ones that carry less weight in Latin America than in developed markets:

QALYs gained as the primary metric (except where formalized, as in Brazil).
Technological innovation per se without translation into health outcomes.
Formal equity weighting (equity does matter, but it does not enter as an explicit numerical weight).

Build a matrix: each product value driver, mapped against its relevance to the specific payer, and against the evidence available to support it. A claim without local evidence is not a defensible claim.

4. Build the economic model with the correct thresholds

The fourth step is the economic model, which must be aligned with the country's actual thresholds, not with international benchmarks.

The explicit thresholds in force in the region (status as of 2026):

Brazil: BRL 40,000 per QALY as the CONITEC reference value, with flexibility up to 3x for specific cases (rare diseases, pediatric, high severity).
Colombia: ~USD 5,181 per QALY according to the official IETS estimate (Espinosa et al., 2022), not formally regulated by the Ministry of Health.
Peru: 1 to 2 UIT per healthy life year gained (~USD 2,500 to USD 5,100).
Rest of the region: implicit thresholds of approximately 1 GDP per capita per QALY, not formally regulated.

The WHO no longer endorses the old 1 to 3 times GDP per capita benchmark, and recent literature (Pichon-Riviere et al., Lancet Global Health, 2023) shows that in 97% of countries the real threshold sits below 1 GDP per capita.

Your value story should defend the ICER against the country's real threshold, not against a generous reference. If the ICER exceeds the threshold, prepare the context argument (severity, rare disease, pediatric population, therapeutic gap) that justifies the flexibility.

5. Anchor the model in recognized reporting standards

The economic model should follow the CHEERS 2022 standard (Consolidated Health Economic Evaluation Reporting Standards, ISPOR), which is the most cited reporting standard in HEOR globally and the reference that evaluators at IETS, CONITEC, and other regional agencies know.

The budget impact analysis should follow the ISPOR Task Force good practice principles (Mauskopf et al., 2007), with the specific payer's perspective, a 1 to 5 year horizon aligned with the budget cycle, justified uptake assumptions, and sensitivity analysis on key parameters.

A dossier that does not follow CHEERS and the ISPOR budget impact principles is not a flawed dossier for one specific reason. It is a dossier that the evaluator will distrust methodologically from the first page.

6. Design the closing narrative: price, access, and managed entry agreement if applicable

The last component of the value story is the operational proposal: price, access conditions, and, if applicable, a managed entry agreement proposal.

For Latin America, financial agreements (discount, price-volume, capping) are the most viable and most implemented. Outcomes-based managed entry agreements remain the exception due to barriers in legal framework, reliable data, and performance monitoring (HTAi Latin American Policy Forum 2023).

If you intend to propose an outcomes-based agreement, arrive with the complete structure: clearly defined clinical outcome, an operable measurement plan, a horizon aligned with the budget cycle, quantified financial consequences, and a dispute resolution mechanism. Without these, the payer will prefer a traditional financial agreement.

7. The final narrative: how all of this gets told

A successful, integrated Latin American value story should be tellable in a single page:

Here is the problem in your system, with your data.
Here is the gap of the current treatment, in clinical and economic terms.
Here is what changes with the product, in the health outcomes that matter to you.
Here is the ICER against your threshold, and the budget impact analysis in your fiscal horizon.
Here is the access proposal and, if applicable, the risk-sharing mechanism.

If the payer can read that page and recognize their system, their budget, and their priorities, the conversation has already started well.

How Quantus solves this

At Quantus we build country-adapted value stories for Latin American submissions, integrating local disease burden, an economic model calibrated to the country's threshold, a budget impact analysis aligned with ISPOR, and an access proposal ready for the specific payer. Six weeks, not six months, with the full package ready for the meeting.

If you have a drug that needs a defensible value story in Latin America, write to us.

References

[1] Husereau D, Drummond M, Augustovski F, et al. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement. Value in Health. 2022;25(1):3-9.

[2] Mauskopf JA, Sullivan SD, Annemans L, et al. Principles of good practice for budget impact analysis: report of the ISPOR Task Force on good research practices: budget impact analysis. Value in Health. 2007;10(5):336-347.

[3] Pichon-Riviere A, Drummond M, Palacios A, et al. Determining the efficiency path to universal health coverage: cost-effectiveness thresholds for 174 countries based on growth in life expectancy and health expenditures. Lancet Global Health. 2023;11(6):e833-e842.

[4] Espinosa O, Rodríguez-Lesmes P, Orozco L, et al. Estimating cost-effectiveness thresholds under a managed healthcare system: experiences from Colombia. Health Policy and Planning. 2022;37(3):359-368.

[5] CONITEC. Recommendations on cost-effectiveness threshold for the SUS. Brazil. 2022.

[6] HTAi Latin American Policy Forum 2023. How can managed entry agreements contribute to coverage decisions in Latin America? International Journal of Technology Assessment in Health Care. 2024;40(1):e65.

[7] Deloitte. Pharmaceutical Market Access Excellence Commercial Framework. Available at: deloitte.com

[8] ZS. Value and Access Journey Strategy. Available at: zs.com