Optum, Merck announce project to test linking payments to drug effectiveness

Dive Brief:

  • UnitedHealth Group’s Optum and Merck recently announced new value-based and pay-for-performance contractual reimbursement models. The two companies said the new models will align prescription drugs payment with patient health outcomes.

  • The “Learning Laboratory” is a multi-year collaboration that will look at the potential of expanding outcomes-based risk sharing agreements (OBRSAs) for payers, pharmacy benefit managers, and pharmaceutical companies. With OBRSAs, payers reimburse drug manufacturers on clinical outcomes.

  • UnitedHealth is reportedly interested in adding five to 10 more outcomes-based deals this year. Humana, Cigna, and Aetna also all have similar deals with pharmaceutical companies, CNBC reported.

Dive Insight:

The project will use real world data to co-develop and test advanced predictive models and co-design OBRSAs to reduce clinical and financial uncertainty with respect to payment for prescription drugs.

Optum’s integrated claims and clinical records will provide the data to test patient care and outcomes. “These data assets will enable the companies to assess OBRSA models across different patient populations, clinical settings, and therapeutic areas aligned with Merck’s product portfolio,” according to Optum.

The collaboration has the potential to affect drug prices. If one type of prescription drug is found to succeed or fail, its price could rise or fall accordingly. Healthcare leaders see a value-based system as a way to control health costs and rising prescription drug costs have become a hot-button issue for consumers as well as Congress.

Payers and the healthcare industry as a whole will be interested in seeing the findings, which the two companies plan to share.

Filed Under: Payer
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