- Harvard Pilgrim, a large New England-based insurer, continues to experiment with new ways of aligning drug cost with patient value, announcing Tuesday two outcomes-based payment contracts with AstraZeneca.
- Such value-based deals have received more attention in recent months, as rising drug prices and high-profile controversies fuel debate over how to measure drug value. Most of these types of agreements remain experiments, testing whether measures ranging from patient outcomes to medication adherence can complement standard volume-based approaches to payments between insurers and drugmakers.
- Harvard Pilgrim has been one of the most active participants, inking deals with large biopharmas like Novartis, Eli Lilly and Amgen. Tuesday's arrangement with AstraZeneca focuses on the diabetes drug Bydureon (exenatide) and the blood thinner Brilinta (ticagrelor).
Deals like the two struck with AstraZeneca can help reduce costs for insurers if a drug fails to live up to its performance in clinical trials. Harvard Pilgrim sees itself as at the forefront of testing this type of payment model and has shown itself willing to sign agreements across various therapeutic classes.
"I do believe that these are important in terms of allocating dollars more so to drugs that have an impact and less so to those that don't have a desired impact," Michael Sherman, Harvard Pilgrim's chief medical officer, told BioPharma Dive in a May interview.
But Sherman acknowledges value-based deals are only one approach to managing pharmaceutical costs — and one that still needs to be tested on a larger scale to demonstrate broader viability.
For AstraZeneca, the agreements signed with Harvard Pilgrim can help secure coverage and underscore its confidence in the drugs' effectiveness.
Both Brilinta and Bydureon are part of a "new cardiovascular and metabolic disease" portfolio that AstraZeneca has flagged as a growth platform, along with respiratory, new oncology and emerging markets.
The categories are meant to highlight the products AstraZeneca believes will help it return to revenue growth. Patent expiries for top brands like Crestor (rosuvastatin) have battered the company's bottom line, sinking product sales 13% in the first quarter of 2017 compared to a year prior.
Brilinta has been boosted by updated guidelines from the American College of Cardiology and the American Heart Association and earned $224 million over the first three months of the year. AstraZeneca expects the drug to hit $1 billion in sales for 2017.
While sales of Bydureon also grew in the first quarter, the drug recently failed to show a superior reduction in major adverse cardiovascular events versus placebo — a missed opportunity that could hurt the drug's competitiveness in a tightening diabetes market.
The deal covering Brilinta will last three years, tying the amount Harvard Pilgrim pays to the drug's ability to reduce hospitalizations for repeat acute coronary events compared to other oral antiplatelet therapies.
Harvard Pilgrim will monitor certain criteria in patients who are discharged following a hospitalization for acute coronary syndrome. If treatment with Brilinta failed to meet the agreed-upon level of reduction in subsequent events, AstraZeneca will charge the insurer a lower amount.
Under the deal for Bydureon, Harvard Pilgrim will measure the ability of patients with type 2 diabetes to reach a predetermined HbA1c goal, provided they correctly adhere to the drug.