- Biogen Inc. will link the price it charges for several of its multiple sclerosis medicines to patient outcomes in an agreement with Prime Therapeutics LLC, a smaller pharmacy benefit manager based in Minnesota.
- While few details were disclosed, Prime indicated the contract would measure patient adherence to the unspecified Biogen drugs included in the deal. Adherence is a frequent component of so-called outcomes-based contracts, although many include several measures of "value."
- Biogen's agreement with Prime is the biotech's only pilot program with a national payer for its multiple sclerosis drugs, a Dec. 1 statement from Prime indicated.
While outcome-based contracts are not new, tracking and monitoring patient outcomes to properly enforce such agreements can pose challenges. And government regulations around price reporting, such as a rule known as Medicaid Best Price, present hurdles for drugmakers. As a result, many of the contracts announced publicly in recent years remain small or in pilot stages.
Of late, however, payers and drugmakers have appeared more interested in brokering outcomes-based contracts, likely reflecting a broader shift in focus from volume to value across the healthcare industry. A survey of PhRMA members earlier this year turned up 16 agreements announced publicly between 2015 through early 2017 — more than double the number disclosed in the two decades prior.
Prime, a smaller PBM than industry majors CVS Health, Optum Inc, and Express Scripts Holding Co., said it inked its first outcomes-based agreement in 2010. More recently, the Minnesota-based company announced agreements with Amgen Inc. and Sanofi SA covering the drugmakers' respective PCSK9 inhibitors.
"With increasing use of specialty medications for complicated diseases, it's extremely important to make sure members are staying on track with their drug therapy regimen," said Prime's Chief Medical Officer Jonathan Gavras in a statement. "Using outcomes data under the pharmacy and medical benefits, Prime can structure these types of drug-specific contracts to help align price to clinical value."
Prime's description is typical of many announcements disclosing outcomes-based agreements. Payers and drugmakers usually are reluctant to reveal many details of the metrics and measures on which such deals are based.
Adherence, however, is frequently a component as both payers and drugmakers can benefit from patients staying on therapy. Insurers don't want to pay for preventable risks when patients don't take a drug, while drugmakers lose out on revenue if patients fall off treatment.
A prominent example of this is Express Scripts' deal with AbbVie Inc. for its hepatitis C medicine Viekira Pak (ombitasvir/paritaprevir/ritonavir; dasabuvir). The PBM guaranteed patient adherence — no small matter, given Viekira's high pill burden — in return for significant discounts on the drug's cost.
In other deals, tracking adherence functions as an enforcement mechanism to ensure patient outcomes are properly tied to treatment.