Dive Brief:
- Health insurance companies are looking to limit spending on specialty drugs by linking their costs to patient outcomes, in an attempt to check the prices set by pharmaceutical companies. Express Scripts is among those developing a plan.
- The issue of specialty drug costs came to a head in 2014 after the health insurance industry was hit with bills for the $1,000-per-pill hepatitis C medication Sovaldi (Gilead).
- According to an estimate by America's Health Insurance Plans, specialty drugs could cost government health programs as much as $50 billion over the next decade.
Dive Insight:
The upside to the issue is that the pharmaceutical industry may be on board as well. Anticipating payment changes, some Massachusetts biopharma companies hope to embrace and capitalize on the pay-for-performance concept.
"Pay-for-performance is the Holy Grail," Genzyme president David Meeker told the Boston Globe. "The challenge is defining the outcome and being able to accurately track and record it."
And on a related note, "We're either going to take this into our own hands or it's going to be done to us," said John Maraganore, chief executive at Alnylam Pharmaceuticals Inc.
Those on both sides of the payer/pharmaceutical issue acknowledge it will take work to reach agreements regarding reporting, monitoring and prices when it comes time to negotiate new payment frameworks. In addition, the criteria are likely to vary significantly among different plans and drugs.