MARA R.A.T.I.N.G.™ METHODOLOGY

Method v1.2.1 — February 2026

1. Purpose & Scope

The MARA R.A.T.I.N.G.™ methodology provides an independent, forward-looking assessment of the likelihood that a medicine — licensed or in late-stage development — will achieve broad reimbursement from leading Health Technology Assessment (HTA) bodies and payers.

A MARA Rating does not evaluate regulatory approval or clinical efficacy in isolation.

It quantifies post-authorisation market-access risk.

The objective is simple:

Enable developers, investors, and decision-makers to know before they go.

2. Rating Philosophy

The MARA R.A.T.I.N.G.™ process adapts internationally recognized risk-rating principles to pharmaceutical market access.

It rests on four core principles:

Multi-factor discipline

Ten structured evidence domains capture clinical value, economic justification, and system integration.

Historical calibration

Domain weights are informed by MARA’s longitudinal rating database, reflecting observed payer behavior.

Independent committee governance

Every rating is determined by a multidisciplinary panel. No single analyst decides.

Continuous surveillance

Ratings are monitored and may be upgraded, downgraded, or placed Under Review when material new evidence emerges.

3. Analytical Framework

3.1 Evaluation Domains

Each asset is assessed across ten standardized domains aligned with HTA logic:

1. Clinical effectiveness
2. Health-related quality of life
3. Cost-effectiveness
4. Safety & tolerability
5. Comparator appropriateness
6. Population representativeness
7. Care-pathway integration
8. Budget impact & resource use
9. Evidence quality & robustness
10. Residual uncertainty & equity considerations

Each domain includes four calibrated sub-domains and is scored using structured qualitative anchors aligned with published HTA precedents.

3.2 Rating Scale

Domain evidence is converted into a composite letter grade from A++ to C:

Proprietary weighting coefficients, non-linear aggregation logic, and break-points are intellectual property of MARA Rating Company AG and are not disclosed.

4. The R.A.T.I.N.G.™ Process Workflow

R — Robust Evidence Review

All publicly available material evidence is collected, validated, and assessed for maturity, reliability, and payer relevance.

A/T — Aligned 10-Domain Assessment & Historical Weighting

Evidence is mapped to structured scorecards. Domain scores are weighted using MARA’s historical database to reflect payer-aligned precedent.

I — Independent Expert Committee

A multidisciplinary panel (HEOR scientists, clinicians, access specialists, pricing strategists) debates assumptions and sensitivity analyses. Minutes are recorded.

N — Neutral Consensus Determination

Consensus is formed through structured deliberation. Issuers may correct factual inaccuracies but cannot alter analytical opinions.

G — Grade Certification & Publication

The final A++–C rating is issued with documented rationale. Publication may be public or confidential at the client’s discretion.

5. Surveillance & Rating Actions

Ratings are monitored at least annually and ad-hoc upon material developments.

Possible actions:

• Upgrade / Downgrade
• Watch Positive / Watch Negative
• Withdrawn (insufficient evidence or discontinuation)

6. Calibration & Performance Monitoring

Each April, MARA’s Expert Committee reviews performance across the prior year.

If:

• False-positive rate exceeds 3%, or
• Overall accuracy drops below 85%,

Coefficient weights are recalibrated.

Threshold bands are stress-tested via bootstrap simulation to maintain ≥95% precision.

A public Annual Results Report is issued each June.

Five-Year Track Record (Current Rule Set)

Across 2020–2025, the MARA model delivered cumulative precision of 97%, with 264 of 272 A-grade assets achieving reimbursement approval by NICE.

Key performance metrics include:

• Accuracy
• False-positive rate (FP)
• False-negative rate (FN)
• Area Under the ROC Curve (AUC)

False-positives represent material capital risk.

False-negatives represent missed upside.

Precision matters.

7. Independence & Governance

• Analysts are excluded from commercial pricing negotiations.
• Committee chairs rotate.
• High-value ratings require a majority of external experts.
• Methodology definitions and surveillance policies are publicly disclosed.
• Proprietary coefficients remain confidential.
• Internal audit benchmarks ratings against observed HTA outcomes.

Independence is structural, not symbolic.

8. Appeals & Corrections

Issuers may request review upon presentation of new, material evidence.

Appeals are heard by a committee independent from the original panel.