Dive Brief:
- Insurers and pharmacy-benefit managers are increasingly pushing for value-based price deals with drug companies in an effort to ensure high-cost prescriptions prove their worth, the Wall Street Journal reported.
- Since 2014 there have been at least a dozen of these deals created, in which insurers may get deeper discounts if patients don't respond to treatment as well as those in clinical trials.
- Cigna announced a milestone this week in becoming the first insurer to achieve value-based contracts for the entire new class of cholesterol drugs known as PCSK9 inhibitors: Praluent, by Sanofi SA and Regeneron Pharmaceuticals Inc., and Repatha by Amgen Inc., which list full price at more than $14,000 per year.
Dive Insight:
While rebate-style drug deals are becoming more common, they are likely to remain limited due to barriers in tracking patient outcomes, experts suggest, which in turn will limit the overall impact such deals may have on U.S. drug spending.
“There is a general increase in interest in exploring these kinds of contracts, but a fair amount of caution as well, largely because the administrative aspects tend to be quite daunting in the short term,” Steven Pearson, president of the Institute for Clinical and Economic Review, told The Wall Street Journal.
Stakeholders note that many drug impacts, such as reductions in heart attacks and deaths from cholesterol drugs, can take years to become apparent and that it can be difficult to follow patients long term due to changes in employment and insurance.
Aside from Cigna, companies including CVS, Express Scripts Holding Co., Humana, Harvard Pilgrim Health Care, and the University of Pittsburgh Medical Center’s health plan have sought deals on high-cost drugs for conditions such as cancer, hepatitis C and heart attacks, The Wall Street Journal reported.